You have four months from the date you receive a denial notice to request an external review. Your external review can be completed through the external review secure portal, which will allow you to check on the status of the external review at any time, and will send you an email notice of each event occurring as the external review progresses, as well as an emailed determination immediately when the external review process is complete.
If you do not wish to type information into the portal, the forms for an external review are available for printing below. Your external review will be processed once the Department receives your documents by mail or fax. Instructions for submitting the external review request on paper are included on the printable form.
Whether you use the secure portal or the printable external review forms, please be sure to complete all required fields and sign the form. Your signature is required, and incomplete forms will be returned.
- The external review portal allows you to appoint an authorized representative as part of your application for an appeal. Similarly, the External Review Form includes a space for you to appoint an authorized representative.
- The External Review Portal allows you to request an expedited external review or challenge a denial of an experimental or investigational medical treatment, which will involve contacting your healthcare provider for them to provide information. Please contact your healthcare provider and obtain an email address to type into the portal - notice will be sent to your healthcare provider using that email, and your healthcare provider can then type information directly into the portal. In the alternative, you can print either or both of these forms, ask your healthcare provider to complete them, and send them to the Department or upload them into the portal