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  10. Chapter 4201 - Utilization ...
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  12. Subchapter H. Appeal of Adverse Determination


Subchapter H. Appeal of Adverse Determination


  • Section 4201.351. Complaint as Appeal
  • Section 4201.352. Written Description of Appeal Procedures
  • Section 4201.353. Appeal Procedures Must Be Reasonable
  • Section 4201.354. Persons or Entities Who May Appeal
  • Section 4201.355. Acknowledgment of Appeal
  • Section 4201.356. Decision by Physician Required; Specialty Review
  • Section 4201.357. Expedited Appeal for Denial of Emergency Care, Continued Hospitalization, Prescription Drugs or Intravenous Infusions
  • Section 4201.358. Response Letter to Interested Persons
  • Section 4201.359. Notice of Appeal
  • Section 4201.360. Immediate Appeal to Independent Review Organization in Life-Threatening Circumstances
  • Section 4201.3601. Immediate Appeal to Independent Review Organization for Denial of Prescription Drugs or Intravenous Infusions
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