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As you may know, the Centers for Medicare & Medicaid Services (CMS) defines
expedited appeal requests as those that could seriously jeopardize the life or
health of the member or the member?s ability to regain maximum function.
Expedited appeal determinations generally must be resolved within 72 hours,
which makes it critical that we receive all relevant medical documentation.
To process expedited member appeals efficiently, especially on weekends and
holidays, it is imperative that we receive legible, up-to-date information
about the member. This includes the latest medical records and any other
information needed to review a determination. A telephone number where you can
be reached is critical, especially if the appeal occurs after hours or on the
weekend. Appeals can be submitted by calling Customer Service at
1-800-645-3965 for Keystone 65 HMO members and 1-888-718-3333 for
Personal Choice 65SM PPO members, or by sending a fax to
215-988-2001.
Also, if you are filing an appeal on behalf of a member and wish to withdraw
the appeal, please send written confirmation as required by CMS.
We greatly appreciate your cooperation so that we may ensure that appeals
are processed timely and that plan decisions are an accurate reflection of the
member?s medical situation.
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