Common use of Expedited Service Authorization Decisions Clause in Contracts

Expedited Service Authorization Decisions. For cases in which a member or provider indicates, or the MCO 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 MCO shall make an expedited service authorization no later than seventy two (72) hours after receipt of the request for service. In Family Care and Partnership, the MCO may extend the timeframes of expedited service authorization decisions by up to eleven (11) additional calendar days if the member or a provider requests the extension or if needed by the MCO to gather more information. For any extension not requested by the member, the MCO must give the member written notice of the reason for delay.

Expedited Service Authorization Decisions. For cases in which a member or provider indicates, or the MCO 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 MCO shall make an expedited service authorization no later than seventy two (72) hours after receipt of the request for service. In Family Care and Partnership, the The MCO may extend the timeframes of expedited service authorization decisions by up to eleven (11) additional calendar days if the member or a provider requests the extension or if needed by the MCO to gather more information. For any extension not requested by the member, the MCO must give the member written notice of the reason for delay.