Section 284-43-3190 - Concurrent expedited review of adverse benefit determinations(1) "Concurrent expedited review" means initiation of both the internal and external expedited review simultaneously to: (a) Review of a decision made under WAC 284-43-2000; or(b) Review conducted during a patient's stay or course of treatment in a facility, the office of a health care professional or other inpatient or outpatient health care setting so that the final adverse benefit determination is reached as expeditiously as possible.(2) A carrier must offer the right to request concurrent expedited internal and external review of adverse benefit determinations. When a concurrent expedited review is requested, a carrier may not extend the timelines by making the determinations consecutively. The requisite timelines must be applied concurrently.(3) A carrier may deny a request for concurrent expedited review only if the conditions for expedited review in WAC 284-43-3170 are not met. A carrier may not require exhaustion of internal review if an appellant requests concurrent expedited review.Wash. Admin. Code § 284-43-3190
WSR 16-01-081, recodified as § 284-43-3190, filed 12/14/15, effective 12/14/15.Amended by WSR 16-14-106, Filed 7/6/2016, effective 8/6/2016 Statutory Authority: RCW 48.02.060, 48.43.525, 48.43.530, 48.43.535, and The Patient Protection and Affordable Care Act, P.L. 111-148, as amended (2010). WSR 12-23-005 (Matter No. R 2011-11), § 284-43-545, filed 11/7/12, effective 11/20/12.