Special Rule for Certain Expedited Service Authorization Decisions. In the case of Expedited Service Authorization decisions that deny or limit services, the CONTRACTOR shall, within seventy-two (72) hours of receipt of the request for service, automatically file an appeal on behalf of the Member, make best effort to give the Member oral notice of the decision of the automatic Appeal, and make a best effort to resolve the Appeal. For purpose of this section, an “Expedited Service Authorization” is a certification requesting urgently needed care or services.
Special Rule for Certain Expedited Service Authorization Decisions. In the case of certain expedited service authorization decisions that deny or limit services, the CONTRACTOR shall, within seventy-two (72) hours of receipt of the request for service, automatically file an Appeal on behalf of the Member, make a best effort to give the Member oral notice of the decision of the automatic Appeal, and make a best effort to resolve the Appeal. For purposes of this Section 4.17.6, “expedited service authorization” is a request for urgently needed care or services. If requested by the Member, the CONTRACTOR shall continue benefits while an Appeal and/or the State Fair Hearing process is pending in accordance with 42 C.F.R. § 438.420 and § 438.424.
Special Rule for Certain Expedited Service Authorization Decisions. In the case of Expedited Service Authorization decisions that deny or limit services, the SE shall, within seventy-two (72) hours of receipt of the request for service, automatically file an appeal on behalf of the consumer, make best effort to give the consumer oral notice of the decision of the automatic Appeal, and make a best effort to resolve the Appeal. For purpose of this Section, an "Expedited Service Authorization" is a certification requesting for urgently needed care or services.
