Common use of Adverse Benefit Determination Due Clause in Contracts

Adverse Benefit Determination Due. to Failure to Provide Covered Services in a Timely Manner Failure to meet the performance standards found in Article 10.4 of this attachment 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 standards found in Article 10.4 of this attachment for offering the first service.

Adverse Benefit Determination Due. to Failure to Provide Covered Services in a Timely Manner Failure to meet the performance standards found in Article 10.4 of this attachment constitutes an Adverse Benefit Determination. The Contractor shall provide a Notice of Adverse Benefit Determination to the Enrollee at the time that either the Contractor determines, or the Enrollee or the Network Provider informs the Contractor Contractor, that the Provider failed to meet the applicable performance standards standard found in Article 10.4 of this attachment for offering the first serviceservice to the Enrollee cannot be met, and the Enrollee informs the Contractor or the Network Provider that they are not satisfied with this.