Section R9-34-213. Contractor Time-frame for Standard Resolution of an Appeal

A.       For standard resolution of an appeal, a contractor shall resolve the appeal and mail the written Notice of Appeal Resolution to the enrollee within 30 days after the day the contractor receives the appeal.

B.       Ifthe enrollee requests an extension of the 30-day time-frame in subsection (A), the contractor shall extend the time-frame up to an additional 14 days.

C.       If the contractor needs additional information and the exten­ sion is in the best interest of the enrollee, the contractor shall extend the time-frame in subsection (A) up to an additional 14 days. If the contractor extends the time-frame, the contractor shall:

1.       Give the enrollee written notice of the reason for the deci­ sion to extend the time-frame, and

2.        Issue and carry out the resolution as expeditiously as the enrollee's health condition requires and no later than the date the extension expires.

D.       If a Notice of Appeal Resolution is not sent within the time­ frame in this Section, the appeal shall be considered denied on the date that the time-frame expires.

Historical Note

New Section made by final rulemaking at 10 A.A.R. 828, effective April 3, 2004 (Supp. 04-1).