Post Appeal Resolution Sample Clauses

Post Appeal Resolution a. If the final resolution of the Appeal in a fair hearing is adverse to the Enrollee, the Agency may recover the cost of the services furnished while the Appeal was pending, to the extent that they were furnished solely because of the requirements of this section. b. The Health Plan must authorize or provide the disputed services promptly, and as expeditiously as the Enrollee's health condition requires, if the services were not furnished while the Appeal was pending and the disposition reverses a decision to deny, limit, or delay services. c. The Health Plan must pay for disputed services, in accordance with State policy and regulations, if the services were furnished while the Appeal was pending and the disposition reverses a decision to deny, limit, or delay services.