Medical Records and Other Information

(1) The RBPO or ACO, as authorized pursuant to 958 CMR 11.13, shall forward the Patient’s medical and treatment records relevant to the review and created by or in the possession or control of the RBPO or ACO, to the identified External Review Agency. (a) In a non-expedited review, any such information shall be forwarded within three business days of receipt of the notification provided pursuant to 958 CMR 11.18. (b) In an expedited review, any such information shall be forwarded within one business day of receipt of the notification provided pursuant to 958 CMR 11.18. (2) The Patient or the Patient’s Authorized Representative may submit additional medical evidence or other relevant information to the External Review Agency and also provide a copy to the RBPO or ACO. (a) The Office of Patient Protection will notify the Patient or the Patient’s Authorized Representative of the right to submit additional medical evidence or other relevant information in its communications with the Patient or Patient’s Authorized Representative. (b) In a non-expedited review, any such additional medical evidence or other relevant information shall be reviewed by the External Review Agency if received within five calendar days from the date of notice from the Office of Patient Protection. Any such additional medical evidence or other relevant information may be reviewed by the External Review Agency if received more than five calendar days from the date of the notice from the Office of Patient Protection, but before the decision is rendered. (c) In an expedited review, any such additional medical evidence or other relevant information shall be reviewed by the External Review Agency if received within 24 hours of the Patient’s or Patient’s Authorized Representative’s filing of the request for expedited external review. Any such additional medical evidence or other relevant information may be reviewed by the External Review Agency if received more than 24 hours after the Patient’s or Patient’s Authorized Representative’s filing of the request for expedited external review but before the decision is rendered.