958 CMR 3.401
Expedited External Review
(1) An insured or the insured's authorized representative may request to have the request for
review processed as an expedited external review.
(2) Each request for an expedited external review shall contain a certification, in writing, from
a health care professional responsible for the treatment or proposed treatment that delay in the
provision or continuation of health care services that are the subject of a final adverse
determination, would pose a serious and immediate threat to the health of the insured.
(3) Upon receiving a properly executed certification that a serious and immediate threat to the
insured exists, the Office of Patient Protection shall qualify such request as eligible for an
expedited external review.
(4) The insured or insured's authorized representative may file a request for expedited external
review concurrently with a request for expedited internal review.
(5) The external review agency shall issue a decision within 72 hours of receiving the request
for expedited external review.