Service Authorization Decisions Not Reached Within Required Time Frames. In the event that the Contractor fails to make a Service Authorization decision within the proscribed time frames, such failure shall constitute a denial of services and shall be considered an adverse Action. The Contractor is required send out a Notice of Action to the Enrollee on the day that the time frame expires.
Appears in 6 contracts
Samples: Chip Dentaquest Amendment 2, Chip Select Health Amendment 1, Chip Premier Access Dental Contract Amendment 2
Service Authorization Decisions Not Reached Within Required Time Frames. In the event that the Contractor fails to make a Service Authorization decision within the proscribed time frames, such failure shall constitute a denial of services and shall be considered an adverse ActionAdverse Benefit Determination. The Contractor is required send out a Notice of Action Adverse Benefit Determination to the Enrollee and the Provider on the day that the time frame expires.
Appears in 4 contracts
Samples: McNa Dental Contract, Premier Access Contract Prepaid Ambulatory Health Plan (Pahp), Prepaid Ambulatory Health Plan (Pahp) Contract
Service Authorization Decisions Not Reached Within Required Time Frames. In the event that the Contractor fails to make a Service Authorization decision within the proscribed time frames, such failure shall constitute a denial of services and shall be considered an adverse ActionAdverse Benefit Determination. The Contractor is required send out a Notice of Action fit Determination to the Enrollee on the day that the time frame expires.
Appears in 3 contracts
Samples: Contract, Health Services Agreement, Contract
Service Authorization Decisions Not Reached Within Required Time Frames. In the event that the Contractor fails to make a Service Authorization decision within the proscribed time frames, such failure shall constitute a denial of services and shall be considered an adverse ActionAdverse Benefit Determination. The Contractor is required to send out a Notice of Action Adverse Benefit Determination to the Enrollee on the day that the time frame expires.
Appears in 2 contracts
Samples: Managed Care Contract, Managed Care Contract
Service Authorization Decisions Not Reached Within Required Time Frames. In the event that the Contractor fails to make a Service Authorization decision within the proscribed time frames, such failure shall constitute a denial of services and shall be considered an adverse Action. The Contractor is required send out a Notice of Action Adverse Benefit Determination to the Enrollee on the day that the time frame expires.
Appears in 2 contracts
Samples: Premier Access Chip Contract, Prepaid Ambulatory Health Plan (Pahp) Contract
Service Authorization Decisions Not Reached Within Required Time Frames. In the event that the Contractor fails to make a Service Authorization decision within the proscribed time frames, such failure shall constitute a denial of services and shall be considered an adverse Action. The Contractor is required send out a Notice of Action to the Enrollee and the Provider on the day that the time frame expires.
Appears in 1 contract
Samples: Prepaid Mental Health Plan Contract
Service Authorization Decisions Not Reached Within Required Time Frames. In the event that the Contractor fails to make a decision on a Service Authorization decision Request within the proscribed time frames, such failure shall constitute a denial of services and shall be considered an adverse Action. The Contractor is required send out a Notice of Action to the Enrollee and the Provider on the day that the time frame expires.
Appears in 1 contract
Samples: Contract
