Common use of Other Adverse Benefit Determinations Requiring Notice of Adverse Benefit Determination Clause in Contracts

Other Adverse Benefit Determinations Requiring Notice of Adverse Benefit Determination. 7.2.1 Adverse Benefit Determination to Reduce, Suspend or Terminate Previously Authorized Covered Services (A) If the Contractor seeks to reduce, suspend, or terminate previously authorized Covered Services, this constitutes an Adverse Benefit Determination. (B) The Contractor shall notify the requesting Provider and mail a Notice of Adverse Benefit Determination to the Enrollee as expeditiously as the Enrollee’s health condition requires and within the following timeframes: