Common use of Notice of Adverse Benefit Determination Clause in Contracts

Notice of Adverse Benefit Determination. In accordance with Article XI, Section D.1., the MCO shall provide written notice of an adverse benefit determination to the member when a decision is made to: Deny or limit a member’s request for a service in the benefit package; Terminate, reduce, or suspend any currently authorized service; or Deny payment for services in the benefit package. In accordance with Article XI, Section D.1., the MCO shall provide a Notification of Non Covered Benefit (xxxxx://xxx.xxx.xxxxxxxxx.xxx/library/f-01283.htm) to the member when a decision is made to: Deny a member’s request for a service outside the benefit package; or Deny a member's request for payment of a service outside of the benefit package.