NY Manual
SHP Manual

New York Provider Manual
15.10 Action Appeals – Medicaid, FHPlus | 15.12 Member Rights to a Fair Hearing – Medicaid, FHPlus

15.11 Expedited Appeals – Medicaid, and Medicaid Advantage Plus, Absolute Care

A Healthfirst member, his or her 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 necessary information and not later than three (3) business days of the date of the receipt of the appeal. 

Notice of an Action Appeal Determination

The notice of a determination on an appeal shall include the detailed reasons for the determination and, in cases where the determination has a clinical basis, the clinical rationale for the determination.   

Healthfirst must send written notice to the member, his or her designee, and the provider (where appropriate) within two (2) business days of the Action Appeal determination.

Healthfirst shall not retaliate or take any discriminatory action against a member because a member or a member’s representative has filed an Action Appeal.