If your provider organization recently denied your internal appeal, you may request an external review of that decision.
The Office of Patient Protection (OPP) administers an external review process where decisions by a Risk-Bearing Provider Organization (RBPO) or Accountable Care Organization (ACO) can be reviewed by an independent doctor or health care professional.
You have 30 days from receipt of a written resolution letter from your RBPO/ACO responding to your internal appeal to request an external review. If your request for an external review is eligible for this process, you will receive a final and binding decision from the external reviewer.
