Denial of Services Sample Clauses

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). 3.5.9.2.2 In addition to including the minimum information specified in Section 3.15.2.3, the Notice of Adverse Benefit Determination must include information to direct the provider if further information or a change in prescription will allow for the treatment to be covered, including but not limited to: a first line or preferred product that would be covered, any missing documentation, whether the drug is not indicated for the member’s diagnosis, and specific elements of the approval criteria not documented on the request form.

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. 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

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,

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 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. The closure of a case;

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: a. Specific reasons for the denial with references to the program provi- sions; b. A description of alternative services recommended on the basis of placement criteria, e.g., Adult Placement Criteria for Drug and Alcohol services. c. A description of the Member’s right to file a Grievance and/or request a DHS Fair Hearing. d. Information for the Member describing how to file a Grievance and/or request a DHS Fair Hearing. e. An offer by the BH-MCO to assist the Member in filing a Grievance and/or DHS Fair Hearing.

Denial of Services. It is the policy of the Credit Union to limit or withdraw services and you agree we have the right to place these restrictions on services otherwise extended to members and/or other parties in the following circumstances: a. In the event that any Credit Union member or other party becomes delinquent on any obligation to the Credit Union, causes a loss to the Credit Union, or makes known their intention to cause a loss to the Credit Union, whether by way of loan default, Account overdraft, or otherwise. b. In 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. Restrictions include, but are not limited to, the right to maintain certain Accounts, the right to payment of certain dividends and interest, and the availability of Electronic Funds Transfer (EFT) services. The EFT services may include without limitation preauthorized transfers, telephone, computer, and mobile access services, and ATM/debit card services. 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 branches, a recommendation of expulsion from the Credit Union, and any other action deemed necessary under the circumstances which is not expressly precluded by the Federal Credit Union Act, National Credit Union Administration Regulations, and our Bylaws.

Denial of Services. The use of the EFT Services is a privilege of membership and not a right. In the event that a 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 member or any other Party has been abusive in the conduct of his or her affairs with the Credit Union, it is our policy to restrict or terminate certain services extended to the member and/or user, including without limitation, telephone, computer, and mobile access services and ATM and Check 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 member’s Accounts. Under certain circumstances, services may be reinstated if any delinquency, loss, or other adverse matter is subsequently cured.