Common use of Continuation of Disputed Services During the Expedited Appeals Process Clause in Contracts

Continuation of Disputed Services During the Expedited Appeals Process. (A) The Contractor shall continue the Enrollee’s disputed services during the expedited Appeal process if: (1) the Action being appealed is to terminate, suspend or reduce a previously authorized course of treatment; (2) the services were ordered by an authorized Provider; (3) the original period covered by the original authorization has not expired; (4) the Enrollee or Provider files the Appeal timely, which means filing the Appeal on or before the later of the following: (i) within 10 days of the Contractor mailing the Notice of Action; or (ii) by the intended effective date of the Contractor’s proposed Action; and (5) the Enrollee requests continuation of disputed services in the Appeal request.