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I. e. Extamal Review Provlalon11: 1. An Adverse Determination Appeal may be submitted for External Review when the amount In dispute exceeds S500 unless the Provider notifies the Company tha,t the Provider intends to submit 11ddltional Adverse Determlnatlon Appeals for External Review on the same or slmllar Iss ues during tl'le on~year period ro!lowlhg the submission or the orig inal Adllerse Determination Appeal and the cumulatrve amount In dispute over the one.year per iod exceeds $50.0. The request fo r External Review Is at the oplion of the Provlder 1 who may Instead choose any other dl spute reaolu tlon a'lloWed by the Agreement . If Clho~en , the Exterrnil Revlew st,aU be bind ing ; 2. The Adverse Determination Appeal mu.st be &u~mltted to Comp_any in writing. The AdmlnfstraUve Manual and ·u:-e Appeal Form for Provider BIiiing Dispute and Madlca/ Neces.sily Denial provides detailed contact info rma ti on . 3. Company will forward Adverse Determ inat ion Appeals that meet the prerequisites as listed in sec tion A above lo a designated External Review Organization . 4. The Provtde r shall pay a fl1 ng fee of$50.00 ior each Adverse Oeterrnlnatlon Appeal. (a) The Company shall notil'y the Prov id11r the filing ree ls due (b) Payment must be e.ubmltted before the External Review begins; provided, howevor, that the Provider sha ll be entitled to .a refund of such payment in the event that lhe Provid.er prevails In the External Rev iew process . (c) Provider shall subml the filing fee within sixty (6-0) calend~r days of notice from the Company that flllng fee Is due or the External Review request will be closed . 5. Upon recelpt of a timely flllng fee, Company wiU provide to the External Review Organization the Appeal Record. 6. The Eirternal Review Organl2alion wm process the Aciverse Determ ination .Appeal and notify the ProVider and Company of Its reoommendat on with in thirty (30) calendar days of rece ip t of the filing fee . The decieton wilt be bindb,g on Company and the Provi der. 7. In the event ll,at the External Review declalon requires payment by ·Company, such payment shall be Initialed within nfleen (15) calendar days after we receive noUce or the determlnallon . Extamal Audit and lnveatlgatlon Appeal Procesa The External Audit and Investigation Appeal Procell& is Intended to give you an opport\ln fty to requetl recons ideration of audit findings lswed by our External Audit and lnve_sllgation Department ood lo ensure we have reviewed all inforrr,a llo n relevant to the audit findings. Please note that contract terminations resulting from audit findings must follow the Provider Contract Termination Appeal ProceSB. II. A. Racon1ldaratlon Requaat Upon rece Jp t of our audit findings, you have forty-flva (45) business days to review and dispute \hese find ings before the audit becomes final. In order lo appeal the find ings, you must submit a written reque111 for a reconsideration of audit findings. You will be glllen the address for where to send your reconsideration request with your audit findings. Asurla Standard MGA ExhlM D Dlapute ReaoluUan Process A1881665<1AA Page • a/9