Reversed Appeal Resolutions. In accordance with 42 CFR §438.424, if the Contractor’s or the State fair hearing decision reverses a decision to deny, limit, or delay services, where such services were not furnished while the appeal was pending, the Contractor must authorize the disputed services promptly and as expeditiously as the enrollee’s health condition requires. Additionally, in the event that services were continued while the appeal was pending, the Contractor must provide reimbursement for those services in accordance with the terms of the final decision rendered by the Division and with the terms of this contract and applicable regulations.
Appears in 5 contracts
Samples: Contract Between the State of Mississippi Division of Medicaid and a Care Coordination Organization (Cco), Contract, Contract
