Common use of Notice of Adverse Benefit Determination Clause in Contracts

Notice of Adverse Benefit Determination. i. The Contractor shall notify the requesting provider, and give the beneficiary written notice of any decision by the Contractor to deny a service authorization request, or to authorize a service in an amount, duration, or scope that is less than requested. The beneficiary’s notice shall meet the requirements of 42 CFR §438.404.

Notice of Adverse Benefit Determination. i. The Contractor Contractor’s subcontractor shall notify the requesting provider, and give the beneficiary written notice of any decision by the Contractor or subcontractor to deny a service authorization request, or to authorize a service in an amount, duration, or scope that is less than requested. The beneficiary’s notice shall meet the requirements of 42 CFR §438.404.

Notice of Adverse Benefit Determination. i. The Pusuant to 42 CFR 438.210(c), the Contractor shall notify provide written notice to the requesting provider, Provider and give the beneficiary written notice Enrollee of any decision by the Contractor to deny a service authorization requestService Authorization Request, or to authorize a service in an amount, duration, or scope that is less than requested. The beneficiaryContractor’s notice notices shall meet the requirements of 42 CFR §438.404.

Notice of Adverse Benefit Determination. i. The Contractor shall notify the requesting provider, provider and give the beneficiary member written notice of any decision by the Contractor to deny deny, reduce, suspend, or terminate a service authorization request, or to authorize a service in an amount, duration, or scope that is less than requested. The beneficiary’s notice shall meet the requirements of requested [42 CFR §457.1260, 42 CFR 457.1230(d), 42 CFR 438.210(c), 42 CFR 438.404, 42 CFR 438.400(b)].