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How to request an ACO/RBPO external review with the Office of Patient Protection (OPP)

If you disagree with a decision of your health care provider, who participates in an RBPO/ACO, you may request an external review by following these steps.
You must submit your external review request within 30 days of being notified by your RBPO/ACO that your internal appeal was denied.

Contacts

Office of Patient Protection

Phone

Main: Call Office of Patient Protection , Main: at (800)-436-7757

Don’t speak English? We can still help. An interpreter will help translate the conversation.

People who are deaf, hard of hearing, late deafened, or speech disabled may reach OPP with MassRelay. Call Office of Patient Protection , People who are deaf, hard of hearing, late deafened, or speech disabled may reach OPP with MassRelay. at TTY and ASCII Users: 800-720-3480; Voice and Hearing Users: 800-720-3479

Online

Email: Email Office of Patient Protection at HPC-OPP@state.ma.us
Useful Resources  

The Details   of How to request an ACO/RBPO external review with the Office of Patient Protection (OPP)

What you need   for How to request an ACO/RBPO external review with the Office of Patient Protection (OPP)

- Written Resolution Letter from the Risk-bearing Provider Organization or Accountable Care Organization indicating that your internal appeal is complete

- Completed OPP External Review Request Form

- Relevant Medical Records or Other Documentation to support your request

 

Fees   for How to request an ACO/RBPO external review with the Office of Patient Protection (OPP)

You do not need to pay a fee to request an external review.  

How to request   How to request an ACO/RBPO external review with the Office of Patient Protection (OPP)


Complete all necessary pages of the OPP external review request form through our secure online form. You will be asked to upload the written resolution letter from your RBPO/ACO and any relevant medical records you wish to include.

Please note: At this time OPP may accept mail only through United States Postal Service with no signature of receipt required. Correspondence mailed that requires a signature or uses other delivery services will be returned to sender.

Please mail your completed request form to: 

Health Policy Commission
Office of Patient Protection
50 Milk Street, 8th Floor
Boston, MA 02109

You may also submit your completed request form in-person at the address above. 

You may also fax your completed request form to 617-624-5046.

OPP cannot accept external review request forms by email. Do not send personal health information or other confidential information to OPP by email.

Next steps   for How to request an ACO/RBPO external review with the Office of Patient Protection (OPP)

  1. 1. Obtain a copy of your written resolution letter from the RBPO/ACO and gather relevant medical records

  2. 2. Complete all necessary pages of the OPP external review request form (if you are requesting an expedited external review, you must complete additional pages)

    RBPO/ACO External Review Form
    RBPO/ACO External Review Request Form (Spanish)
    RBPO/ACO External Review Request Form (Spanish)

  3. 3. Submit your external review request form to OPP within 30 days of receiving your written resolution letter

More info   for How to request an ACO/RBPO external review with the Office of Patient Protection (OPP)

See here for frequently asked questions (FAQs) about the RBPO/ACO external review process. 

What happens after I submit my external review request form?

You will either receive a letter from OPP stating that your request is eligible for external review or you will receive a letter from OPP stating that your request is ineligible and the reason why it is ineligible.

If your request is eligible, the letter will notify you which external review agency is handling your request. If you want to provide additional documentation or medical records for your appeal, you must send those records to the external review agency directly within 5 calendar days of OPP’s letter for a standard review. If you have additional information to submit on an expedited external review request, please call OPP.

Contact   for How to request an ACO/RBPO external review with the Office of Patient Protection (OPP)

Address
Massachusetts Health Policy Commission - Office of Patient Protection
50 Milk Street, 8th Floor, Boston, MA 02109
Directions 
Phone
Main: Call Office of Patient Protection , Main: at (800)-436-7757

Don’t speak English? We can still help. An interpreter will help translate the conversation.

People who are deaf, hard of hearing, late deafened, or speech disabled may reach OPP with MassRelay. Call Office of Patient Protection , People who are deaf, hard of hearing, late deafened, or speech disabled may reach OPP with MassRelay. at TTY and ASCII Users: 800-720-3480; Voice and Hearing Users: 800-720-3479
Online
Email: Email Office of Patient Protection at HPC-OPP@state.ma.us
Useful Resources  
Fax
1-617-624-5046

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