Massachusetts · Regulations
958 CMR 11.00 — Internal appeals process and external review process for risk-bearing provider organizations and accountable care organizations
24 sections
24 sections
- 958 CMR 11.01Scope and Purpose
- 958 CMR 11.02Definitions
- 958 CMR 11.03Right to an Internal Appeal
- 958 CMR 11.04Information on Internal Appeals
- 958 CMR 11.05Form and Manner of Request for Internals Appeals
- 958 CMR 11.06Risk-bearing Provider Organization and Accountable Care Organization Records of Appeals
- 958 CMR 11.07Time Limits for Resolution of Internal Appeals
- 958 CMR 11.08Internal Reviewers
- 958 CMR 11.09Form of Written Resolution of the Internal Appeal
- 958 CMR 11.10External Review
- 958 CMR 11.11Expedited External Review
- 958 CMR 11.12Fees
- 958 CMR 11.13Consent to Release of Medical Information
- 958 CMR 11.14Form and Manner of Request for External Review
- 958 CMR 11.15Screening of Requests for External Review
- 958 CMR 11.16Requests Ineligible for External Review – Notification
- 958 CMR 11.17Assignment of External Reviews
- 958 CMR 11.18Notification of Assignment and Request for Information
- 958 CMR 11.19Medical Records and Other Information
- 958 CMR 11.20Conflict of Interest
- 958 CMR 11.21Decisions and Notice
- 958 CMR 11.22Confidentiality
- 958 CMR 11.23Reporting Requirements
- 958 CMR 11.24Severability