KRS 304.17A-619: Duty of covered person, authorized person, or provider to provide

insurer with new information regarding internal appeal -- Time frame for

insurer to render a decision based on new information -- Insurer's failure to

make timely determination or provide written notice.

(1) (a) If the covered person, authorized person, or provider has new clinical

information regarding the covered person's internal appeal, he or she shall

provide that information to the insurer prior to the initiation of th e external

review process.

(b) The insurer shall have five (5) business days from the date of the receipt of

the information to render a decision based on the new information.

(c) If new information is provided in accordance with this subsection, the sixty

(60) day time frame for commencing an external review as set forth in KRS

304.17A-623(4), shall not begin to run, until the insurer or its designee

renders a decision regarding the new information.

(2) The insurer's failure to make a determination or prov ide a written notice within the

time frames set forth in KRS 304.17A-617 shall be deemed to be an adverse benefit

determination, other than a coverage denial, by the insurer for the purpose of

initiating an external review as set forth in KRS 304.17A-623.