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The request must be received by Company within forty-five (45) business days of your receipt of the audit findings and must include, at a minimum, the following: ■ A detailed statement of the issue(s) in dispute ■ At the election of the Provider, notification of a request for a meeting with the panel reviewing the issue(s) in dispute • Any documents which the Provider contends supports his/her position (Exception: Please note that all documentation required to justify your billing, including but not limited to chart notes, must be present in your files at the time of an audit. Additions to file documentation and/or the production of files that were not made available to us at the time of an audit will not be considered in connection with an appeal involving adverse audit findings. We will, however, consider your explanation as to why the documentation was not present at the time of the audit.) If we do not receive such a reconsideration request within forty-five (45) business days of your receipt of the audit findings, the findings will be final. The request for reconsideration will be reviewed by the manager of our External Audit and Investigation Department, investigators within that department, and other Company representatives, as determined by the manager of the department (hereinafter referred to as the "Panel"). At the discretion of the Panel, a Company Medical Director may be consulted prior to the final decision. A meeting, prior to the Panel's review of your request for reconsideration, can be arranged either at your office or a Company office, as mutually convenient. You must request this meeting when submitting your request for reconsideration. At the meeting, you may appear in person and may be accompanied by an attorney or other representative. You and your representative may make an oral statement to the Panel and respond to questions from the Panel. The purpose of this meeting is to give you an opportunity to present your position to the Panel in person. If the Panel needs additional documentation to reach a decision, the additional documentation must be submitted within twenty (20) calendar days of the date of the Panel's written request for information, unless your written request for a reasonable extension of time is granted. ■ If the requested documentation is received on time, it will be included in the request for reconsideration. • If the documentation is not received on time, the request for reconsideration will continue and a decision will be made based on the information originally submitted. You will be sent written notice of the decision within forty-five (45) business days following the meeting with the Panel or, if no such meeting was requested, within forty-five (45) business days of our receipt of the audit reconsideration request, not including the time waiting for additional information from you. During the period of time in which we are waiting for additional information, the appeal decision time frame is suspended until the information is received or the time to respond to the request has expired. The decision on an audit reconsideration request is deemed final forty-five (45) business days after your receipt of the Panel's decision, unless a timely written request for a Medical Director Review is received. III. B. Medical Director Review If you are not satisfied with the decision made following the reconsideration request to the Panel, you may request a Medical Director Review of the audit findings. The written request for a Medical Director Review and any supporting information must be received by Company within forty-five (45) business days of your receipt of the Panel's decision. The address where to send your request will be included in our response to your request for reconsideration. The Medical Director Review will be held no more than forty-five (45) business days following receipt of the request, not including the time in which the Company is waiting for additional information from you. The review will be conducted by a Medical Director who was not involved in an earlier review of the audit findings. Asuris Standard MGA Exhibit D Dispute Resolution Process Al8816854AA Page 5 of 9