NY Manual
SHP Manual

New York Provider Manual
15.16 Appealing the Grievance – Commercial, CHPlus | 15.18 External Review – Commercial, CHPlus

15.17 Expedited Appeals – Commercial, CHPlus

A Healthfirst member, the member’s representative, or a participating provider may request expedited consideration of an appeal if the standard time frame would seriously jeopardize the life or health of the member or the member’s ability to regain maximum function. Expedited appeals are processed within two (2) business days of receipt of requested information and within no more than 72 hours of receipt of the request. The notice of determination regarding the appeal will include the reason(s) for a Healthfirst decision, including any clinical factors. Appeals for services previously provided are not eligible for an expedited appeal. Appeal of claims determinations are also not eligible for an expedited appeal.