Current through Register Vol. 30, No. 50, December 13, 2024
Section R9-34-214 - Contractor Process for an Expedited Resolution of an AppealA. A contractor shall establish and maintain a review process for an expedited appeal. The contractor shall conduct an expedited appeal if: 1. The contractor receives a request for an appeal from an enrollee and the contractor determines that taking the time for a standard resolution could seriously jeopardize the enrollee's life or health, or ability to attain, maintain, or regain maximum function;2. The contractor receives a request for an expedited appeal from an enrollee supported with documentation from the provider that taking the time for a standard resolution could seriously jeopardize the enrollee's life or health, or ability to attain, maintain, or regain maximum function; or3. The contractor receives a request for an expedited appeal directly from a provider, with the enrollee's written consent, and the provider indicates that taking the time for a standard resolution could seriously jeopardize the enrollee's life or health, or ability to attain, maintain, or regain maximum function.B. The contractor shall ensure that punitive action is not taken against a provider who requests an expedited resolution or who supports an enrollee's appeal.C. If the contractor denies a request for expedited resolution of an appeal from an enrollee, the contractor shall: 1. Resolve the appeal within the time-frame in R9-34-213; and2. Make reasonable efforts to give the enrollee prompt oral notice of the denial, and follow up within two calendar days with a written notice. Ariz. Admin. Code § R9-34-214
New Section made by final rulemaking at 10 A.A.R. 828, effective April 3, 2004 (Supp. 04-1).