Expedited External Review
Effective Apr 28, 2023Mass. Register #1494MGL c. 6D, § 16 MGL c. 176OMassachusetts Health Policy Commission
- (1) An insured or the insured's authorized representative may request to have the request for review processed as an expedited external review.
- (2) Each request for an expedited external review shall contain a certification, in writing, from a health care professional responsible for the treatment or proposed treatment that delay in the provision or continuation of health care services that are the subject of a final adverse determination, would pose a serious and immediate threat to the health of the insured.
- (3) Upon receiving a properly executed certification that a serious and immediate threat to the insured exists, the Office of Patient Protection shall qualify such request as eligible for an expedited external review.
- (4) The insured or insured's authorized representative may file a request for expedited external review concurrently with a request for expedited internal review.
- (5) The external review agency shall issue a decision within 72 hours of receiving the request for expedited external review.