Common use of Adverse Benefit Determination Due to Failure to Provide Clause in Contracts

Adverse Benefit Determination Due to Failure to Provide. Covered Services in a Timely Manner Any failure of the Contractor’s Network Providers to provide services in a timely manner constitutes an Adverse Benefit Determination. The Contractor shall provide a Notice of Adverse Benefit Determination to the Enrollee at the time either the Enrollee or provider informs the Contractor that the provider failed to meet the performance benchmarks for appointment waiting times found in Article 10.2.6.

Adverse Benefit Determination Due to Failure to Provide. Covered Services in a Timely Manner Any failure of the Contractor’s Network Providers to provide services in a timely manner constitutes an Adverse Benefit Determination. The Contractor shall provide a Notice of Adverse Benefit Determination to the Enrollee at the time either the Enrollee or provider Provider informs the Contractor that the provider Provider failed to meet the performance benchmarks for appointment waiting times found in Article 10.2.6.

Adverse Benefit Determination Due to Failure to Provide. Covered Services in a Timely Manner Any failure of the Contractor’s Network Participating Providers to provide services in a timely manner constitutes an Adverse Benefit Determination. The Contractor shall provide a Notice of Adverse Benefit Determination to the Enrollee at the time either the Enrollee or provider informs the Contractor that the provider failed to meet the performance benchmarks for appointment waiting times found in Article 10.2.6.