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The request must be received by Company within forty-five (45) business day• 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 re11iewing the i&&ue(s) in dispute Any documents which the Pro11ider contends supports hia/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 flies that were not made available to us at the time of an audit wlU 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 ror reconsideration will be re11iewed by the manager of our External Audit and Investigation Department, ln11e1tigators within that department, and other Company representatives, as determined by the manager of the department (hereinafter referred lo 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 reque•t 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 representali11e. You and your representative may make an oral statement to the Panel and respond to questions from the Panel. The purpose of 1h19 meeting is to gh1e 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 lime 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 wlll 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 induding 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 hes expired. The decision on an audit reconslderallon request is deemed final forty-five (451 buslnus days after your receipt of the Panel's decision, unless a tlmaly written request for a Medical Director Review la nH:elved, Ill. a. Medical Director Review If you are not satisfied wrth 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 ?anel's decl&ion. The address where to send your request wlll 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 Ume in which the Company is waiting far 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. Aauns Standard MGA Exhibit O Dispute Resolution Procen A18ll16854AA Page~ ol9