CompFox AI Summary
This case involved a dispute over the timeliness of utilization review (UR) denials for the applicant's requested medical treatment. The original judge found the denials untimely due to issues with proof of service and communication timelines. However, on reconsideration, the Appeals Board found that the City of Los Angeles had provided sufficient evidence of timely fax transmissions for both UR denials. Therefore, the Board rescinded the original decision and substituted new findings that both UR denials were timely.
Full Decision Text1 Pages
This case involved a dispute over the timeliness of utilization review (UR) denials for the applicant's requested medical treatment. The original judge found the denials untimely due to issues with proof of service and communication timelines. However, on reconsideration, the Appeals Board found that the City of Los Angeles had provided sufficient evidence of timely fax transmissions for both UR denials. Therefore, the Board rescinded the original decision and substituted new findings that both UR denials were timely.
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