Regulation .08 Time for Rendering Final Decisions Resulting from Internal Grievance Process.
Regulation .08 Time for Rendering Final Decisions Resulting from Internal Grievance Process.LinkCopy Citation
A.
Except as otherwise provided in this regulation, a carrier shall render a final decision on a grievance that involves a:
(1)
Prospective denial in a nonemergency case within 30 working days after the filing date; and
(2)
Retrospective denial within 45 working days after the filing date.
B.
With the written consent of the member, member’s representative, or health care provider who filed a grievance on behalf of the member, a carrier may extend the period for making a final decision for an additional period of not longer than 30 working days.