Denial of Services. Provider shall not deny services to a Medicaid recipient during the period that the recipient is covered under the Medicaid fee-for-service program prior to the effective date of the recipient’s enrollment with Health Plan under the Medical Assistance Program.
Denial of Services. 3.5.9.2.1 If the Contractor denies a request for prior authorization, the Contractor must issue a Notice of Adverse Benefit Determination within 24 hours of receiving the request for prior authorization (see Section 3.15.2 of this Contract for Notice of Adverse Benefit Determination requirements).
Denial of Services. A determination made by a BH-MCO in response to a Provider's or Member’s request for approval to provide a service of a specific amount, duration and scope which:
Denial of Services. 2. The closure of a case;
Denial of Services. Except for maintaining a non-dividend bearing share account and the right to vote in special and annual meetings, USALLIANCE may deny all services to any member or any member of a credit union with which we have merged who has caused a financial loss, has engaged in fraud or forgery, who is suspected of being the victim of fraud or a scam, even if the member authorized the transaction(s), or whose conduct is deemed inappropriate or abusive. Denial of services may also occur due to your Credit Union account(s) being in default, including lending products; a legal or administrative proceeding involving your account(s); suspected fraud or illegal activity; or to comply with any federal, state, or local law, rule, or regulation. We may decline, reverse, freeze, or restrict transactions to or from your account(s), and/or hold or remove funds from your account(s) pending investigations. Denial of services also means you cannot conduct business on your behalf or on behalf of another. For security and regulatory reasons, there may be additional limitations on the type, dollar amount or number of transactions permitted at certain times to safeguard your accounts against misuse or when you have failed to follow proper procedures for accessing your accounts. USALLIANCE may also restrict the method in which business may be conducted, such as removing access to Online Banking and/or ATM/Debit Cards/Credit Cards, prohibiting access to USALLIANCE premises or to services involving USALLIANCE personnel. Federal Insurance: Member deposits are federally insured up to $250,000 by the National Credit Union Share Insurance Fund, which is administered by the National Credit Union Administration, a U.S. government agency.
Denial of Services. In the event that any Credit Union member or other Party becomes delinquent on any obligation to the Credit Union, causes us a loss or makes known his or her intention to cause us a loss, whether by way of loan default, account overdraft, or otherwise, xxxx the event that any Credit Union member or other Party has been abusive in the conduct of his or her affairs with the Credit Union, it is our policy to restrict or withdraw member services otherwise extended to that member and/or other Party, including but not limited to, the right to maintain accounts (except a Primary Savings), the right to payment of certain dividends and interest, and the availability of electronic fund transfer services, including pre-authorized transfers, telephone and computer access services, and ATM services, and you agree that we may do so. An abusive Party is subject to further sanctions as appropriate, including without limitation, denial of specific services that involve personal contact with Credit Union employees, denial of access to Credit Union facilities, a recommendation of expulsion from the Credit Union, and any other action deemed necessary under the circumstances which is not expressly precluded by the Texas Credit Union Act and Credit Union Commission Rules, and our Bylaws.
Denial of Services. The Primary Contractor’s BH-MCO must have a procedure that allows Members to grieve denials of requests for authorization for services. Individuals responsible for denying services or reviewing Grievances of denials must have the necessary and appropriate clinical training and experience. All denials must be made by a physician or, in some cases, by a licensed psychologist. Prior to denying services requested for an individual under 21, a peer-to-peer review must be conducted. Denials of inpatient care must be approved by a physician. Qualifications of individuals must be consistent with Appendix AA, and all applicable Commonwealth laws and regulations. The BH-MCO may not deny or reduce the amount, duration, or scope of a required service solely because of a Member’s diagnosis, type of illness or condition. If a service for which the request for authorization is denied is viewed by the prescriber and the Member as an Urgent or Emergency Service, the Primary Contractor’s BH-MCO must have a process for expedited review of such Grievances to occur within 24 hours of the request. Any time the Primary Contractor’s BH-MCO denies a request for authorization for service, the Primary Contractor’s BH-MCO must notify the Member or the parent/custodian of a child or adolescent, in writing. The written notification must include:
Denial of Services. The use of the EFT Services is a privilege of membership and not a right. In the event that the Primary Member or any other Party becomes delinquent on an obligation to us, causes us a loss, or makes known his or her intention to cause us a loss, whether by way of loan default, account overdraft, or otherwise, or in the event that a Primary Member or any other Party has been abusive in the conduct of his or her affairs with the Credit Union, including repeated overdrafts, it is our policy to restrict or terminate certain services extended to the Primary Member and/or other Parties, including without limitation, telephone, computer, and mobile access services and ATM and debit card services, and you acknowledge that we may do so. Any electronic access restrictions we may impose under these circumstances may apply to all of the Primary Member’s accounts. Under certain circumstances, services may be reinstated if any delinquency, loss, or other adverse matter is subsequently cured.
Denial of Services. Except for maintaining a non-dividend bearing share account and the right to vote in special and annual meetings, HVCU may deny all services to any member or member of a credit union with which we have merged who has caused a financial loss, has engaged in fraud or forgery, or whose conduct is deemed inappropriate or abusive. Denial of services also includes the inability to conduct business on your behalf or on behalf of another. HVCU may also restrict the method in which business may be conducted, such as prohibiting access to HVCU premises or to services involving HVCU personnel. Notification of Death, Incapacitation, or Dissolution. HVCU may continue to honor all transfer orders, withdrawals, deposits, or other transactions on an account until we receive notification by any means we deem appropriate informing us if any account signer dies, becomes incapacitated, or if your business is dissolved. Even with knowledge, HVCU may for ten days after the date of death, incapacity, or dissolution pay or guarantee checks drawn on or prior to that date, unless ordered in writing to stop payment by an individual claiming an interest in the account under rules established by us. Upon the death of any account owner, HVCU reserves the right to enforce a statutory lien (except accounts prohibited by law) to pay any amounts owed to HVCU prior to releasing funds to other owners, beneficiaries, etc. Dormant Accounts and Unclaimed (Abandoned) Property. If you have not made any transactions over a period of 24 months and we have been unable to contact you, your account may be classified by us as dormant. A fee is assessed against the account. In accordance with each state law, unclaimed property and funds in abandoned accounts are remitted to the custody of the applicable state agency and we will have no further liability to you for such funds. Unclaimed property may also include negotiable instruments that remain outstanding or stock certificates that remain on deposit. You must apply to the appropriate state agency to reclaim such funds. Employer Identification Number. HVCU requires an Employer Identification Number (EIN) or Social Security Number for Sole Proprietors and single member LLCs, to establish a business account. Mailing Address. You must inform us of your current postal mailing address at all times. Failure to do so which causes undeliverable periodic statements will result in fees for each statement period until you provide us with your current address. Sta...
Denial of Services. Any determination made by the PH-MCO in response to a request for approval which: disapproves the request completely; or approves provision of the requested service(s), but for a lesser amount, scope or duration than requested; or disapproves provision of the requested service(s), but approves provision of an alternative service(s); or reduces, suspends or terminates a previously authorized service. An approval of a requested service which includes a requirement for a Concurrent Review by the PH-MCO during the authorized period does not constitute a Denial of Service. Denied Claim — An Adjudicated Claim that does not result in a payment obligation to a Provider. Department — The Department of Human Services of the Commonwealth of Pennsylvania. Deprivation Qualifying Code — The code specifying the condition which determines a Recipient to be eligible in nonfinancial criteria. Developmental Disability — A severe, chronic disability of an individual that is: Attributable to a mental or physical impairment or combination of mental or physical impairments. Manifested before the individual attains age twenty-two (22). Likely to continue indefinitely. Manifested in substantial functional limitations in three or more of the following areas of life activity: – Self care; – Receptive and expressive language; – Learning; – Mobility; – Capacity for independent living; and – Economic self-sufficiency. Reflective of the individual’s need for special, interdisciplinary or generic services, supports, or other assistance that is of lifelong or extended duration, except in the cases of infants, toddlers, or preschool children who have substantial developmental delay or specific congenital or acquired conditions with a high probability of resulting in Developmental Disabilities if services are not provided. Disease Management — An integrated treatment approach that includes the collaboration and coordination of patient care delivery systems and that focuses on measurably improving clinical outcomes for a particular medical condition through the use of appropriate clinical resources such as preventive care, treatment guidelines, patient counseling, education and outpatient care; and that includes evaluation of the appropriateness of the scope, setting and level of care in relation to clinical outcomes and cost of a particular condition. Disenrollment — The process by which a Member’s ability to receive services from a PH-MCO is terminated. DHS Fair Hearing — A heari...
