Section 3.405 - Screening of Requests for External Review(1) The Office of Patient Protection shall screen all requests for external reviews to determine ifthey:(a) comply with the requirements of 958 CMR 3.404;(b) do not involve a service or benefit that has been explicitly excluded from coverage by the carrier in its evidence of coverage; and(c) result from a carrier's issuance of a notice of final adverse determination; provided, however, that no final adverse determination is necessary where the carrier has failed to comply with timelines for the internal grievance process, the carrier has waived the internal grievance process in writing pursuant to 958 CMR 3.300(3), or if the insured or his or her authorized representative is requesting an expedited external review at the same time that the insured is requesting an expedited internal review pursuant to 958 CMR 3.401(4).(2) An external review request with evidence submitted by an insured of noncompliance with 958 CMR 3.300 through 3.310 shall be decided in favor of the insured unless the carrier provides substantial evidence, such as proof of delivery, that the carrier properly complied with the time limits required by 958 CMR 3.300 through 3.310.(3)Screening of requests for expedited reviews shall begin within 48 hours of receipt. Screening of all other requests shall begin within five business days of receiptAmended by Mass Register Issue 1494, eff. 4/28/2023.