Common use of Review with Stay Denials Clause in Contracts

Review with Stay Denials. a) CONTRACTOR shall offer a peer-to-peer MD review to the facility prior to issuing a clinical denial based on not meeting medical necessity for either acute or administrative stay. CONTRACTOR shall not extend the peer-to-peer review determination period beyond 24 hours. Once the peer-to-peer MD review is offered and if facility does not respond or if the attending Medical Doctor does not call for the review, CONTRACTOR shall issue the denial. Determination regarding authorization or denial shall be completed within twenty-four (24) hours from the time of a completed request.

Review with Stay Denials. a) CONTRACTOR shall offer a peer-to-peer MD review to the facility prior to issuing a clinical denial based on not meeting medical necessity for either acute or administrative stay. ; CONTRACTOR shall not extend pend authorizations while waiting for the peer-to-peer review determination period beyond 24 hoursto occur. Once the peer-to-peer MD review is offered and if facility does not respond or offered, CONTRACTOR shall issue the denial if the attending Medical Doctor does not call for the review, CONTRACTOR shall issue the denial. Determination regarding authorization or denial shall be completed within twenty-four (24) hours from the time of a completed request.