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.
Appears in 4 contracts
Samples: Managed Care Services Agreement, Services Agreement, Managed Care Services Agreement
