Title 958 CMR 11.00 - Internal Appeals Process and External Review Process for Risk-bearing Provider Organizations and Accountable Care Organizations
- Section 11.01 - Scope and Purpose
- Section 11.02 - Definitions
- Section 11.03 - Right to an Internal Appeal
- Section 11.04 - Information on Internal Appeals
- Section 11.05 - Form and Manner of Request for Internals Appeals
- Section 11.06 - Risk-bearing Provider Organization and Accountable Care Organization Records of Appeals
- Section 11.07 - Time Limits for Resolution of Internal Appeals
- Section 11.08 - Internal Reviewers
- Section 11.09 - Form of Written Resolution of the Internal Appeal
- Section 11.10 - External Review
- Section 11.11 - Expedited External Review
- Section 11.12 - Fees
- Section 11.13 - Consent to Release of Medical Information
- Section 11.14 - Form and Manner of Request for External Review
- Section 11.15 - Screening of Requests for External Review
- Section 11.16 - Requests Ineligible for External Review - Notification
- Section 11.17 - Assignment of External Reviews
- Section 11.18 - Notification of Assignment and Request for Information
- Section 11.19 - Medical Records and Other Information
- Section 11.20 - Conflict of Interest
- Section 11.21 - Decisions and Notice
- Section 11.22 - Confidentiality
- Section 11.23 - Reporting Requirements
- Section 11.24 - Severability