Section 22-B6006. GENERAL PROCEDURES FOR EXTERNAL REVIEW

 

6006.1Within thirty (30) business days after the date of receipt of an adverse formal internal review grievance decision, the member or member representative may file a request for an external review with the Director.

 

6006.2Each member or member representative filing a request for external review shall file with the insurer and Director a written consent form executed by the member authorizing the release of the member's medical records to third parties for the sole purpose of conducting the review.

 

6006.3Unless a request to extend the time for rendering a grievance decision has been made pursuant to § 6003.9, a request for external review may be filed if the grievance decision is not received by the 30th business day after the filing of the grievance.

 

6006.4The Director may refuse to accept a request for external review if the member or member representative fails to provide a signed consent form.

 

6006.5Within five (5) business days after receipt of a request for external review, the Director shall send written notice to the insurer, stating that a request for an external review has been filed and specifying any information required by the Director to be submitted by the insurer.

 

6006.6Except for matters involving an emergency or urgent medical condition, the insurer shall provide to the Director any information requested by the Director in the written notice within seven (7) business days after the date the insurer is notified of a request for an external review.

 

source

Final Rulemaking published at 47 DCR 229 (January 14, 2000).