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.
Appears in 2 contracts
Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
Special Rule for Certain Expedited Service Authorization Decisions. In the case of Expedited Service Authorization certain expedited service authorization decisions that deny or limit services, the CONTRACTOR shall, within seventy-two (72) 72 hours of receipt of the request for service, automatically file an appeal on behalf of the Membermember, make a best effort to give the Member member oral notice of the decision of the automatic Appealappeal, 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 servicesappeal.
Appears in 2 contracts
Samples: Medicaid Managed Care Services Agreement (Molina Healthcare Inc), Agreement No. PSC 02 05 (BHC Physician Services of Kentucky LLC)
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 for urgently needed care or services.
Appears in 1 contract
Samples: Medicaid Long Term Services Agreement (Amerigroup Corp)
Special Rule for Certain Expedited Service Authorization Decisions. In the case of Expedited Service Authorization 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 Membermember, make a best effort to give the Member member oral notice of the decision of the automatic Appealappeal, 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 servicesappeal.
Appears in 1 contract
Samples: Medicaid Managed Care Services Agreement (Molina Healthcare Inc)
