Common use of Services Requiring Prior Authorization Clause in Contracts

Services Requiring Prior Authorization. The Contractor shall provide, or arrange for the provision of, Covered Services as expeditiously as the Enrollee's health condition requires. Ordinarily, Covered Services shall be provided within fourteen (14) calendar days after receiving the request for service from a Provider, with a possible extension of up to fourteen (14) calendar days, if the Enrollee requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee will not be harmed by the extension. If the Physician indicates, or the Contractor determines that following the ordinary time frame could seriously jeopardize the Enrollee's life or health, the Contractor shall provide, or arrange for the provision of, the Covered Service no later than seventy-two (72) hours after receipt of the request for service, with a possible extension of up to fourteen (14) calendar days, if the Enrollee requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee will not be harmed by the extension.

Services Requiring Prior Authorization. The Contractor shall provide, or arrange for the provision of, Covered Services as expeditiously as the Enrollee's ’s health condition requires. Ordinarily, Covered Services shall be provided within fourteen (14) calendar days after receiving the request for service from a Provider, with a possible extension of up to fourteen (14) calendar days, if the Enrollee requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee will not be harmed by the extension. If the Physician indicates, or the Contractor determines that following the ordinary time frame could seriously jeopardize the Enrollee's ’s life or health, the Contractor shall provide, or arrange for the provision of, the Covered Service no later than seventy-two (72) hours after receipt of the request for service, with a possible extension of up to fourteen (14) calendar days, if the Enrollee requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee will not be harmed by the extension.

Services Requiring Prior Authorization. The Contractor shall provide, or arrange for the provision of, Covered Services as expeditiously as the EnrolleeBeneficiary's health condition requires. Ordinarily, Covered Services shall be provided within fourteen (14) calendar days after receiving the request for service from a Provider, with a possible extension of up to fourteen (14) calendar days, if the Enrollee Beneficiary requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee Beneficiary will not be harmed by the extension. If the Physician indicates, or the Contractor determines that following the ordinary time frame could seriously jeopardize the EnrolleeBeneficiary's life or health, the Contractor shall provide, or arrange for the provision of, the Covered Service no later than seventy-two (72) hours after receipt of the request for service, with a possible extension of up to fourteen (14) calendar days, if the Enrollee Beneficiary requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee Beneficiary will not be harmed by the extension.

Services Requiring Prior Authorization. The Contractor shall provideauthorize or deny Covered Services, or arrange for the provision ofincluding pharmacy services, Covered Services that require prior authorization as expeditiously as the Enrollee's ’s health condition requires. Ordinarily, Covered Services authorizations or denials shall be provided within fourteen (14) calendar days after receiving the request for service authorization from a Provider, with a possible extension of up to fourteen (14) calendar additional days, if the Enrollee requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee will not be harmed by the extension. If the Physician indicates, or the Contractor determines determines, that following the ordinary time frame could seriously jeopardize the Enrollee's ’s life or health, the Contractor shall provide, authorize or arrange for the provision of, deny the Covered Service no later than seventy-two (72) hours after receipt of the request for serviceauthorization, with a possible extension of up to fourteen (14) calendar days, if the Enrollee requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee will not be harmed by the extension.

Services Requiring Prior Authorization. The Contractor shall provide, or arrange for the provision of, Covered Services as expeditiously as the EnrolleeBeneficiary's health condition requires. Ordinarily, Covered Services shall be provided within fourteen (14) calendar days after receiving the request for service from a Provider, with a possible extension of up to fourteen (14) calendar days, if the Enrollee Beneficiary requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee Beneficiary will not be harmed by the extension. If the Physician indicates, or the Contractor determines that following the ordinary time frame could seriously jeopardize the EnrolleeBeneficiary's life or health, the Contractor shall provide, or arrange for the provision of, the Covered Service no later than seventy-two (72two(72) hours after receipt of the request for service, with a possible extension of up to fourteen (14) calendar days, if the Enrollee Beneficiary requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee Beneficiary will not be harmed by the extension.

Services Requiring Prior Authorization. The Contractor shall provide, or arrange for the provision of, Covered Services as expeditiously cxpcditiously as the EnrolleeEnrollcc's health condition requires. Ordinarily, Covered Services shall be provided within fourteen (14) calendar days after receiving the request for service from a Provider, with a possible extension of up to fourteen (14) calendar days, if the Enrollee requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee will not be harmed by the extension. If the Physician indicates, or the Contractor determines that following the ordinary time frame could seriously jeopardize the EnrolleeEnrollcc's life or health, the Contractor shall provide, or arrange for the provision of, the Covered Service no later than seventy-two (72) hours after receipt of the request for service, with a possible extension of up to fourteen (14) calendar days, if the Enrollee requests the extension or the Contractor provides written justification to the Department that there is a need for additional information and the Enrollee will not be harmed by the extension.