Service Authorization means that Open Ecosystem Partner needs to meet specific qualification requirements for the products included in a “Service” Product Family that Open Ecosystem Partner wants to promote and offer Services for as set out in detail in the Open Ecosystem Program Guide.

Service Authorization means a managed care Enrollee’s request, or a Provider’s request, on behalf of an Enrollee, for the provision of services, and the MCO’s determination of the Medical Necessity for the medical service and authorization of Home and Community Based Services prior to the delivery or payment of the service. Home and Community Based Services are not subject to the Medical Necessity definition in this section.

Service Authorization means that Partner needs to meet specific qualification requirements for the products included in a “Service” Product Family that Partner wants to promote and offer Services for as set out in detail in the PartnerEdge Program Guide and the applicable RSPI.

Examples of Service Authorization in a sentence

Immediate Service Authorization Beginning on the date of enrollment, the MCO is responsible for providing the member with needed services in the benefit package.
Service Authorization Approval Notices When the Contractor denies a Service Authorization request or authorizes services in an amount, duration, and scope less than requested, the Contractor shall send a notice in accordance with Section 1.15.2: “Adverse Benefit Determinations” of this Contract.
Use of Approved Service Authorization Policies The IDT shall use the MCO’s Department-approved service authorization policies and procedures to authorize services.
Authorization Denials and Peer-to-Peer Review In accordance with 42 C.F.R. § 438.210(b)(3), any decision to deny a Service Authorization request or to authorize a service in an amount, duration, or scope that is less than requested shall be made by an individual who has appropriate expertise in addressing the Dental Health Plan Enrollee’s oral health needs.
The Contractor shall permit Providers to request a peer-to-peer review process for all Service Authorization denials or authorizations in an amount, duration, or scope less than requested.

More Definitions of Service Authorization

Service Authorization means the process of service necessity determination and service authori- zation of scope, amount and duration by the review organization.

Service Authorization means the process of determining service necessity and the level of care and number of units of service to be provided to a child.

Service Authorization. A Member’s request for the provision of a service.

Service Authorization means a process through which a request for provisional approval of coverage is submitted to the Contractor or the Department for review.

Service Authorization means the approval required from the designated authority for reimbursement for certain Medicaid services.

Service Authorization. The Health Plan’s approval for services to be rendered. The process of authorization must at least include a Health Plan Enrollee’s or a Provider’s request for the provision of a service.