CID Management Appeal Process
The CID Management appeal process addresses all disagreements and clinical issues with regard to determinations of medical necessity issued by CID reviewers. For example, a person might choose to submit an appeal if:
the UR decision was made without considering important information;
the reviewer misinterpreted the available information;
the evidence based treatment guidelines were misapplied;
the reviewer failed to consider a sound reason for variance from the guidelines; and/or
there is disagreement with the reviewer’s logic.
The appeal process focuses on the clinical correctness of the determination of medical necessity. Each appeal reviews is conducted by a qualified physician who is different from the reviewer on the original review.
Non-clinical issues, such as concerns about the utilization review process or personnel, should be not be addressed via the appeals process but should instead be addressed through the CID Grievance process.
Appeals may be requested by the patient/injured worker; or the provider or facility providing services. No other persons may request an appeal, except as required under applicable state law.
The timeframe for filing an appeal can be found on your original determination letter.
Requests for an appeal review must be made in writing and must contain the following information; unless applicable state requirements are different:
The requestor’s name
The requestor’s address
The requestor’s telephone number
The CID review # that is being appealed
Medical information above and beyond that which was submitted with the original request for authorization (this can be a statement of the reason(s) for disagreement with the original determination; and/or medical documentation)
The CID Appeal Request Form may be used to provide the information needed to start the appeal process; but use of the form is not required.
Appeal requests may be faxed to 877-628-6724; or may be mailed to: CID Management PO Box 4379 Westlake Village, CA 91359