Expedited Authorizations. For requests in which a provider indicates, or the Contractor determines that, following the standard timeframe could seriously jeopardize the Enrollee’s life or health or ability to attain, maintain, or regain maximum function, the Contractor must make an expedited authorization decision and provide notice as expeditiously as the Enrollee’s health condition requires and not later than seventy-two (72) hours after receipt of the request for services. The Contractor may extend this period by up to fourteen (14) calendar days if the Enrollee requests an extension, or if the Contractor justifies, to the DHCS upon request, a need for additional information and how the extension is in the Enrollee’s interest. Any decision delayed beyond the time limits is considered a denial and must be immediately processed as such.
Expedited Authorizations. For requests in which a provider indicates, or the Contractor determines that, following the standard timeframe could seriously jeopardize the Enrollee’s life or health or ability to attain, maintain, or regain maximum function, the Contractor must make an expedited authorization decision and provide notice as expeditiously as the Enrollee’s health condition requires and not later than seventy-two (72) hours after receipt of the request for
Expedited Authorizations. For requests in which a Provider indicates, or Contractor or a Subcontractor determines that, following the standard timeframe for Prior Authorizations could seriously jeopardize the Member’s life or health or ability to attain, maintain, or regain maximum function, the Contractor must make an expedited authorization decision and provide notice as expeditiously as the Member’s health condition requires and not later than 72 hours after receipt of the request for services. The Contractor may extend the 72 hours’ time period by up to 14 calendar days if the Member requests an extension, or if the Contractor justifies, to the satisfaction of DHCS upon request, a need for additional information and how the extension is in the Member’s interest. Any decision delayed beyond the time limits is considered a denial and must be immediately processed as such.
Expedited Authorizations. For requests in which a provider indicates, or the Contractor determines that, following the standard timeframe could seriously jeopardize the Member’s life or health or ability to attain, maintain, or regain maximum function, the Contractor must make an expedited authorization decision and provide notice as expeditiously as the Member’s health condition requires and not later than three (3) working days after receipt of the request for services. The Contractor may extend the three (3) working days’ time period by up to 14 calendar days if the Member requests an extension, or if the Contractor justifies, to the DHCS upon request, a need for additional information and how the extension is in the Member’s interest. Any decision delayed beyond the time limits is considered a denial and must be immediately processed as such.
Expedited Authorizations. Contractor must make expedited authorization decisions for service requests where a Member’s Provider indicates, or Contractor, Subcontractor, or Network Provider determines that, following the standard timeframe for Prior Authorizations could seriously jeopardize the Member’s life or health or ability to attain, maintain, or regain maximum function, Contractor must make an expedited authorization decision and provide notice as expeditiously as the Member’s health condition requires and not later than 72-hours after receipt of the request for services in accordance with 42 CFR section 438.210(d). Contractor may extend the 72-hour time period by up to 14 calendar days if the Member requests an extension, or if Contractor justifies, to the satisfaction of DHCS upon request, a need for additional information and how the extension is in the Member’s interest. Any decision delayed beyond the time limits is considered a denial and must be immediately processed as such.
Expedited Authorizations. For requests in which a Provider indicates, or FHS determines that, following the standard timeframe could seriously jeopardize the Member’s life or health or ability to attain, maintain, or regain maximum function, FHS must make an expedited authorization decision and provide notice as expeditiously as the Member’s health condition requires and not later than three (3) working days after receipt of the request for services. FHS may extend the three (3) working days’ time period by up to fourteen (14) calendar days if the Member requests an extension, or if FHS justifies, to DHCS upon request, a need for additional information and how the extension is in the Member’s interest. Any decision delayed beyond the time limits is considered a denial and must be immediately processed as such.
Expedited Authorizations. For requests in which a provider indicates, or the Alliance determines that, following the standard timeframe could seriously jeopardize the Eligible Member’s life or health or ability to attain, maintain, or regain maximum function, Alliance must make an expedited authorization decision and provide notice as expeditiously as the Eligible Member’s health condition requires and not later than three (3) working days after receipt of the request for services. Alliance may extend the three (3) working days time period by up to (14) calendar days if the Eligible Member requests an extension, or if Alliance justifies, to DHCS upon request, a need for additional information and how the extension is in the Eligible Member’s interest. Any decision delayed beyond the time limits is considered a denial and must be immediately processed as such.
Expedited Authorizations. Three (3) working days after receipt of the request for service (these are requests in which a provider indicates, or the Contractor determines, that following the standard timeframe could seriously jeopardize the Member’s life or health or ability to attain, maintain, or regain maximum function). The time limit may be extended by up to 14 calendar days if the Member requests an extension, or if the Contractor can provide justification upon request by the State for the need for additional information and how it is in the Member’s interest. Any decision delayed beyond the time limits is considered a denial and must be immediately processed as such.
