General Quality of Care Review: Preparing the Reconsideration/Final

5120.2 – General Quality of Care Review: Preparing the Reconsideration/Final Determination Package (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) The QIO receives the review materials and completed QRD from the reconsideration Peer Reviewer and examines it to ensure all necessary information is returned. The QIO identifies the reconsideration decision on the QRD Form and prepares the “General Quality of Care Review Final Reconsideration Letter for Practitioner/Provider” (See Appendix 5-7). The QIO should use the language in the General Quality of Care Reviews: Initial Determination Letter unless substantial changes have been made. The QIO must notify the practitioner/provider of the QIO’s Final Determination (as summarized in the Letter) no later than five (5) calendar days after receiving the request for reconsideration, or if later, five (5) calendar days after receiving any medical or other records needed for the reconsideration.