Screening of Requests for External Review

(1) The Office of Patient Protection shall screen all Patient requests for external reviews to determine if they: (a) Comply with the requirements of 958 CMR 11.00; (b) Do not involve an issue within the purview of the Patient’s Carrier; and (c) Result from an RBPO’s or ACO’s written resolution of the internal appeal upholding the decision that is the subject of the appeal; provided, however, that no written resolution is necessary where the RBPO or ACO has failed to comply with timelines for the internal appeals process.