Common use of Time Frames and Procedures for Standard Service Authorizations Clause in Contracts

Time Frames and Procedures for Standard Service Authorizations. (A) When making Standard Service Authorization Approvals the Contractor shall make a decision and provide notice to the Enrollee and Provider as expeditiously as the Enrollee’s health condition requires, but no later than 14 calendar days from the receipt of the request for Service Authorization. (1) The Contractor may extend the time frame for making the decision by up to an additional 14 calendar days if: (i) the Enrollee or the Provider requests an extension; or (ii) the Contractor justifies (to the Department upon request) a need for additional information and how the extension is in the Enrollee’s best interest. (2) If the Contractor extends the time frame for making standard Service Authorization decisions the Contractor shall: (i) Give the Enrollee written notice of the reason for the decision to extend the time frame; (ii) Inform the Enrollee of his or her right to file a Grievance, and how to do so, if the Enrollee disagrees with the decision; and (iii) Issue and carry out the determination as expeditiously as the Enrollee’s health condition requires and no later than the date the extension expires.

Time Frames and Procedures for Standard Service Authorizations. (A) When making Standard Service Authorization Approvals the Contractor shall make a decision and provide notice to the Enrollee and Provider as expeditiously as the Enrollee’s health condition requires, but no later than 14 calendar days from the receipt of the request for Service Authorization. (1) The Contractor may extend the time frame for making the decision by up to an additional 14 calendar days if: (i) the Enrollee or the Provider requests an extension; or (ii) the Contractor justifies (to the Department upon request) a need for additional information and how the extension is in the Enrollee’s best interest. (2) If the Contractor extends the time frame for making standard Service Authorization decisions the Contractor shall: (i) Give give the Enrollee written notice of the reason for the decision to extend the time frame; (ii) Inform inform the Enrollee of his or her their right to file a Grievance, and how to do so, if the Enrollee disagrees with the decision; and (iii) Issue issue and carry out the determination as expeditiously as the Enrollee’s health condition requires and no later than the date the extension expires.