![]() Expedited appeals are available when precertification of urgent or ongoing services has been denied and a delay in decision making might seriously jeopardize the life or health of the member or otherwise jeopardize the member’s ability to regain maximum function. What can I do if I am contesting an urgent matter? According to our policies, we only allow one level of provider appeal. Can all practitioners and organizational providers file both Level 1 and Level 2 appeals? ![]() See the quick reference guide for our timeframes for responding to reconsideration or appeal. What is the timeframe for responding to a dispute? ![]() See the quick reference guide for the timeframes to submit a reconsideration or appeal. The member appeal process applies to appeals related to pre-service or concurrent medical necessity decisions. For these types of issues, the practitioner and organizational provider appeal process only applies to appeals received subsequent to the services being rendered. Utilization review decisions are decisions made during the precertification, concurrent or retrospective review processes for services that require precertification. For example, decisions related to the provider contract, our claims payment policies, or processing error.
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