Table 1: Timeline Requirements by State


Informal


Formal


Urgent Care


Prospective


Concurrent


Retrospective


Expedited Review
Alabama 45 calendar days 30 calendar days 3 working days
Alaska 30 days 30 days 72 hours
Arizona
Arkansas
California 3 calendar days
Colorado 72 hours
Connecticut Non- Medical Necessity Adverse Determination: Twenty (20) days Medical Necessity Adverse Determination: 30 calendar days Medical Necessity Adverse Determination: 30 calendar days Medical Necessity Adverse Determination: 60 calendar days Medical Necessity Adverse Determination: 72 hours or 24 hours depending on the condition
Delaware Coverage: 30 days; All Other (non-coverage) 45 days 72 hours 72 hours
District of Columbia 30 calendar days 60 calendar days 24 hours
Florida
Georgia
Guam
Hawaii 60 days 72 hours
Idaho
Illinois
Indiana 20 days 45 days
Iowa
Kansas 20 working days
Kentucky
Louisiana
Maine First Level Reviews of Adverse Benefit Determinations Not Involving Health Care Treatment Decisions: 30 days
Maryland For Coverage Decisions: 60 working days; 30 calendar days after appeal decision Medical Necessity: 30 working days Medical Necessity: 45 working days For Adverse Decisions or Grievances: 30 working days or 45 working days for retrospective denials; Medical Necessity: 24 hours
Massachusetts 30 days 72 hours Decisions on Denial of Coverage or Durable Medical Equipment: 48 hours; Decisions on Terminal Illness: 5 days
Michigan 30 calendar days; if insurer procedure includes two (2) steps to resolve grievances: 15 calendar days 60 calendar days; if insurer procedure includes two (2) steps to resolve grievances: 30 calendar days 72 hours
Minnesota Written Appeal: 30 days; Hearing Appeal: 45 days
Mississippi
Missouri First Level Reviews: 15 working days 72 hours
Montana 30 days 60 days 72 hours
Nebraska 15 working days 72 hours
Nevada 30 days 72 hours
New Hampshire If two (2) mandatory levels of appeal are required: first level 15 days and second level 30 days 30 days 3 days; if single mandatory level of appeal: 60 days 72 hours
New Jersey
New Mexico
New York For Referrals or Covered Benefits: 30 days; For All Other: 45 days; For All Appeals: 30 business days For Serious Risk to Health: 48 hours; For Appeals of Serious Risk to Health: 2 business days; For Serious Risk to Health: 48 hours
North Carolina For First Level Reviews: 30 days For Second Level Reviews: 4 days
North Dakota
Ohio 30 days 7  days
Oklahoma
Oregon
Pennsylvania First Level: 30 days; Second Level: 45 days 48 hours
Puerto Rico Non-Adverse Determination: 30 calendar days; Voluntary Level: 10 business days or 45 calendar days if no appearance at hearing First Level Review: 15 calendar days First Level Review: 30 calendar days 48 hours
Rhode Island
South Carolina
South Dakota First Level Review: 30 days First Level Review: 60 days 72 hours
Tennessee First Level Review: 30 days; Second Level Review: 5 days First Level Review: 60 days 72 hours
Texas 30 calendar days 1 business day
Utah 72 hours
Vermont Non-Adverse Determination: 60 calendar days; Continued or Extended Treatment: 24 hours; For HMOs, 15 days 30 calendar days First Level: 24 hours 60 calendar days If Written: 72 hours; If Oral: 24 hours
Virgin Islands
Virginia
Washington
West Virginia 60 days; Non-Adverse Determinations: 20 days First Level: 30 days First Level: 60 days 72 hours
Wisconsin 30 days 72 hours
Wyoming