Time Frames and Procedures for Denying All or Part of a Service Authorization Request. If the Contractor denies a Service Authorization Request, or authorizes a requested service in an amount, duration or scope that is less than requested, the Contractor shall make the decision and give a Notice of Action to the Enrollee as expeditiously as the Enrollee’s health condition requires it, but no later than 14 calendar days from receipt of the request for Service Authorization. The Contractor shall also notify the requesting Provider, although the notice need not be in writing.
Appears in 10 contracts
Samples: Prepaid Mental Health Plan, Prepaid Mental Health Plan Contract, Prepaid Mental Health Plan Contract
Time Frames and Procedures for Denying All or Part of a Service Authorization Request. If the Contractor denies a Service Authorization Request, or authorizes a requested service in an amount, duration or scope that is less than requested, the Contractor shall make the decision and give a Notice of Action Adverse Benefit Determination to the Enrollee as expeditiously as the Enrollee’s health condition requires it, but no later than 14 calendar days from receipt of the request for Service Authorization. The Contractor shall also notify the requesting Provider, although the notice need not be in writing.
Appears in 4 contracts
Samples: McNa Dental Contract, Premier Access Contract Prepaid Ambulatory Health Plan (Pahp), Prepaid Ambulatory Health Plan (Pahp) Contract
