Effectuation of Reversed Appeal Resolutions a) If the PHP, during the plan appeal, or the Administrative Law Judge, during the State Fair Hearing, reverses a decision to deny, limit, or delay services that were not furnished while the appeal was pending, the PHP shall authorize or provide the disputed services promptly and as expeditiously as the Member’s health condition requires and no later than seventy-two (72) hours from the date it receives notice reversing the determination. 42 C.F.R. § 438.424(a).
Effectuation of Reversed Appeal Resolutions. 9.12.1 Services not furnished while the appeal is pending If the Contractor or the State Fair Hearing officer reverses a decision to deny, limit, or delay services that were not furnished while the appeal was pending, the Contractor must authorize or provide the disputed services promptly, and as expeditiously as the member's health condition requires.
Effectuation of Reversed Appeal Resolutions. 50 9.12.1 Services Not Furnished While the Appeal is Pending 50 9.12.2 Services Furnished While the Appeal is Pending 50 10 REPORTING REQUIREMENTS 51 10.1 Contractor's Network Providers and Subcontractors 51
Effectuation of Reversed Appeal Resolutions. 1. If the PIHP, during the plan Appeal, or the Administrative Law Judge, during the State Fair Hearing, reverses a decision to deny, limit, or delay services that were not furnished while the Appeal was pending, the PIHP shall authorize or provide the disputed services promptly and as expeditiously as the member’s health condition requires and no later than seventy- two (72) hours from the date it receives notice reversing the determination. 42 C.F.R. § 438.424(a).
Effectuation of Reversed Appeal Resolutions
