WCUM Reviews and Appeals

January 10, 2019

 


 WCUM Reviews and Appeals 


Adverse Determination Provision


Appeal Requirements Provision


Timeframe for Appeal Determination


Emergency Services Provision


Timeframe for Emergency Services Determination 


External Appeals Permitted
Alabama Yes Yes 30 calendar days Yes No time provided Yes
Alaska No No No provision No No provision No provision
Arizona Yes Yes, for external appeals 7 days No No provision Yes
Arkansas No Yes 30 days No No provision No provision
California Yes Yes 30 days Yes 30 days No provision
Colorado No Yes No provision No No provision Yes
Connecticut Yes No 15 days or 30 days if hearing held Yes 2 days No
Delaware Yes No No provision No No provision Yes
District of Columbia Yes Yes No provision No No provision Yes
Florida No Yes 120 days No No provision No provision
Georgia No Yes No provision Yes No timeframe provided No provision
Guam
Hawaii No Yes No provision No No provision No provision
Idaho No No No provision No No provision No provision
Illinois Yes Yes No provision Yes No timeframe provided No provision
Indiana No Yes No provision No No provision Yes
Iowa No No No provision No No provision No provision
Kansas No Yes No provision No No provision No provision
Kentucky Yes Yes 10 days Yes 24 hours for expedited UR determinations No provision
Louisiana Yes Yes 15 calendar days Yes No timeframe provided Yes
Maine Yes Yes 1 business day No No provision Yes
Maryland Yes Yes 24 hours Yes 2 hours No provision
Massachusetts Yes Yes 2 business days (for prospective and concurrent reviews); 20 days (for retrospective reviews) Yes No timeframe provided Yes
Michigan Yes Yes No provision Yes 60 days Yes
Minnesota Yes Yes No provision Yes No timeframe provided No provision
Mississippi Yes Yes 20 days Yes No timeframe provided Yes
Missouri Yes No No provision No No provision No provision
Montana Yes Yes 30 days (prospective); 60 days (retrospective) Yes No timeframe provided Yes
Nebraska No Yes No provision Yes No timeframe provided Yes
Nevada No No No provision No No provision No provision
New Hampshire Yes Yes No provision Yes No timeframe provided No provision
New Jersey No Yes No provision Yes No timeframe provided Yes
New Mexico Yes Yes No provision No No provision Yes
New York Yes Yes 60 days to make determination and 2 days to notify; 2 business days (expedited) or 24 hours (expedited inpatient substance use disorder treatment) Yes No timeframe provided Yes
North Carolina Yes Yes No provision Yes No timeframe provided No provision
North Dakota Yes No No provision Yes No timefrrame provided No provision
Ohio No No No provision No No provision No provision
Oklahoma No No No provision No No provision No provision
Oregon Yes Yes No provision No No provision Yes
Pennsylvania Yes Yes No provision No No provision Yes
Puerto Rico
Rhode Island No No No provision No No provision No provision
South Carolina Yes Yes 30 days or 2 days for expedited reviews No No provision No provision
South Dakota Yes Yes No No No provision No provision
Tennessee Yes Yes Within 7 days if approval of previously declined claim; 48 hours for expedited reviews Yes No timeframe provided Yes
Texas Yes Yes No provision Yes No timeframe provided Yes
Utah Yes Yes No provision No No provision No provision
Vermont Yes Yes No provision No No provision Yes
Virgin Islands
Virginia No No No provision No No provision No provision
Washington Yes No No provision No No provision No provision
West Virginia Yes Yes No provision No N provision Yes
Wisconsin No No No provision No No provision No provision
Wyoming No Yes For small claims, 75 days; For all other cases, 30 days; if the contested case is heard by the hearing panel, 45 days No No provision Yes