Common use of Expedited Authorizations Clause in Contracts

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 three (723) hours working days after receipt of the request for services. The Contractor may extend this the three (3) working day’s time 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.