Timeline Standards -Beneficiary Problem Resolution

Category	Timeline	Who
Grievances	An expression of dissatisfaction about any matter other than an NOABD.
Filing	Any time	Beneficiaries or an authorized representative
Acknowledgement	5 calendar Days	Provider or MCP
Standard Resolution	90 calendar days	Provider or MCP
Exempt Resolution	24 hours	Provider or MCP
Expedited Resolution	72 hours	Provider or MCP
Notice of Adverse Benefit Determination	A Notice Sent to Beneficiaries with regard to an action taken by the MCP which may adversely affect their services.
Termination, Suspension, or Reduction of a previously authorized services	At least 10 days before the date of action except permitted by other State and Federal exceptions to the beneficiary	Provider or MCP
Appeals	A review by an MCP of a NOABD.
Filing	60 calendar days of the date of NOABD	Beneficiaries or an authorized representative
Acknowledgement	5 calendar Days	MCP
Standard Resolution	30 calendar days	MCP
Expedited Resolution	72 hours	MCP
Extension	14 calendar days	MCP
Notification of Extension	Reasonable efforts to provide prompt oral notice Written notice within 2 calendar days.	MCP
Effectuation of Overturned Decisions	72 hours	MCP
Internal Fair Hearings	An equitable process to manage unsponsored beneficiary grievances and/or an appeal of a provider level grievance.
Filing	120 days	Beneficiaries or authorized representative.
Acknowledgement	5 calendar days	Designated Investigator
Standard Resolution	30 calendar days	Designated Investigator
Expedited Resolution	72 hours	Designated Investigator
Extension	14 calendar days	Designated Investigator
Notification of Extension	Reasonable efforts to provide prompt oral notice Written notice within 2 calendar days.	Designated Investigator
State Hearings	In response to the Notice of Appeal Resolution.
Filing	120 days from NAR	Beneficiaries or authorized representative.
Standard Resolution	90 calendar days	State Hearings Division
Expedited Resolution	3 working days	State Hearings Division
Effectuation of Overturned Decisions	72 hours	State Hearings Division

Timeline Standards -Beneficiary Problem Resolution

Category​​​​​​

Timeli​ne

W​ho

​​​Griev​ances

An expression of dissatisfaction about any matter other than an NOABD.

​Notice of Adverse Benefit Determination

A Notice Sent to Beneficiaries with regard to an action taken by the MCP which may adversely affect their services.

Appeals

A review by an MCP of a NOABD.

​Internal Fair Hearings

An equitable process to manage unsponsored beneficiary grievances and/or an appeal of a provider level grievance.

​State Hearings

In response to the Notice of Appeal Resolution.​

Category

Timeline

Who

Grievances

Notice of Adverse Benefit Determination

Internal Fair Hearings

State Hearings

In response to the Notice of Appeal Resolution.