Internal Reviewers
Effective Sep 7, 2018Mass. Register #1373MGL c. 6D, § 15 MGL c. 6D, § 16 MGL c. 176O, § 24Massachusetts Health Policy Commission
- (1) The RBPO or ACO shall ensure that an Internal Reviewer determines the resolution of the internal appeal.
- (2) An Internal Reviewer shall determine whether the Patient has an Urgent Medical Need that warrants an expedited internal appeal. The Internal Reviewer determining Urgent Medical Need and the Internal Reviewer determining the resolution of the internal appeal may be the same individual.