(1) If the covered person, authorized person, or provider has new clinical information regarding the covered person’s internal appeal he or she shall provide that information to the insurer prior to the initiation of the external review process. The insurer shall have five (5) business days from the date of the receipt of the information to render a decision based on the new information. If new information is provided in accordance with this section, the sixty (60) day time frame for commencing an external review as set forth in KRS § 304.17A-623(4), shall not begin to run, until the insurer or its designee renders a decision regarding the new information.
(2) The insurer’s failure to make a determination or provide a written notice within the time frames set forth in KRS § 304.17A-617 shall be deemed to be an adverse determination by the insurer for the purpose of initiating an external review as set forth in KRS § 304.17A-623.

Terms Used In Kentucky Statutes 304.17A-619

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Insurer: means any insurance company. See Kentucky Statutes 304.17A-005
  • provider: means any:
    (a) Advanced practice registered nurse licensed under KRS Chapter 314. See Kentucky Statutes 304.17A-005

Effective: July 14, 2000
History: Created 2000 Ky. Acts ch. 262, sec. 10, effective July 14, 2000.

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