application will be brought back to MAC to formalize the denial . The Committee will notify the practitioner in writing on its decision within 10 business days of the meeting . The written notification will contain NPDB reporting language and notify the provider that they may reapply in 3 years if they wish to again be considered as part of the Hometown Health Network . Provider ’ s formalized denial will be reported to the NPDB within 30 days of the final decision .
LEVEL II APPEAL
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1 . The Level II appeal is initiated at the request of the practitioner writing the Senior Clinical Staff Person or his / her designee .
2 . The Level II Appeal will be scheduled no later than 60 days after receipt of request by the denied practitioner unless agreed upon by both the appellant and MAC .
3 . The Level II Appeal is conducted by a five person panel comprised of three ( 3 ) randomly selected Hometown Health practitioners . Practitioners will include at least one clinical peer of comparable specialty . The panel will also include Hometown Health ’ s CEO or designee and another Hometown Health staff member not involved in the Level I appeal , if a Level I appeal has previously occurred .
4 . The Level II Appeal will be considered a formal appeal , and the appealing provider may be represented by counsel at his / her own expense . Minutes of the meeting will be taken .
5 . The Senior Clinical Staff Person or his / her designee will present the reason ( s ) for the denial of credentialing of the practitioner .
6 . The practitioner can provide any material he / she feels is relevant , but it must be :
• Detailed
• Documented in writing by the appellant and / or accompanied by supporting documentation , and
• Verifiable ; either orally , written , or through Internet website date , through acceptable sources identified in Hometown Health ’ s Standards for Participation policy and procedure .
• Any material supplied by the appellant must be received no later than two weeks before the scheduled Level II appeal meeting in order to be considered at the meeting .
7 . The practitioner will be notified in writing of the panel ’ s decision within 10 business days of the meeting . The written notification will include the panel ’ s findings based upon the information considered . If the provider was denied , the