Over the desk
Ask Mindful
Ask about a client, ask for the draft, or ask what is due. The answer comes from this desk and cites its rules. A person still signs, and a person still records the filing.
Matching primary seed-rule summaries are below. Open the source and check its applicability before using it.
Layers searched that had a match: 1 Federal law/regulation.
Layers with no match for this question: 2 State regulation (Virginia); 3 State Medicaid manual (DMAS); 4 MCO contract / provider manual; 4 MCO contract/manual; 5 Payer clinical criteria; 6-7 Accreditation / case law / guidance. A rule found in one layer can still be changed by another, especially the plan's own contract (layer 4) and the program's policies (layer 7), which are not loaded.
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Payer contracts, proprietary criteria, and internal policies are not loaded.
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F-006 Who can file an appeal and when
An enrollee has 60 calendar days from the date on the adverse benefit determination notice to request an appeal with the plan (oral or written). The plan may have only one level of appeal. With the enrollee's written consent, and if state law permits, a provider or authorized representative may file the appeal, file a grievance or request a State fair hearing on the enrollee's behalf; BUT providers cannot request continuation of benefits.
438.402(b), (c)(1)(ii), (c)(2)(ii), (c)(3)(ii) · rev eCFR as of 2026-09-28 · P
Caution Virginia adds its own rules for members (12VAC30-120-420, L-006). Some MCOs publish a consent form (Anthem has one) - get each plan's form.