31.10.18.08

.08 Time for Rendering Final Decisions Resulting from Internal Grievance Process.

A. Except as otherwise provided in this regulation, a carrier shall render a final decision on a grievance that involves a:

(1) Prospective denial in a nonemergency case within 30 working days after the filing date; and

(2) Retrospective denial within 45 working days after the filing date.

B. With the written consent of the member, memberís representative, or health care provider who filed a grievance on behalf of the member, a carrier may extend the period for making a final decision for an additional period of not longer than 30 working days.