Common use of Time Frames for Notice of Decisions Clause in Contracts

Time Frames for Notice of Decisions. a. The PH-MCO must process each request for Prior Authorization of a service and notify the Member of the decision as expeditiously as the Member’s health condition requires, or at least orally, within two (2) Business Days of receiving the request, unless additional information is needed. If no additional information is needed, the PH-MCO must mail written notice of the decision to the Member, the Member’s PCP, and the prescribing Provider within two (2) Business Days after the decision is made. The PH-MCO may make notification of coverage approvals via electronic notices as permitted under 28 Pa. Code 9.753(b). If additional information is needed to make a decision, the PH-MCO must request such information from the appropriate Provider within forty-eight (48) hours of receiving the request and allow fourteen (14) days for the Provider to submit the additional information. If the PH-MCO requests additional information, the PH-MCO must notify the Member on the date the additional information is requested, using the template, N(7) Request for Additional Information Letter available in Docushare.

Time Frames for Notice of Decisions. a. The PH-MCO must is required to process each request for Prior Authorization (prospective utilization review) of a service and notify ensure that the Member is notified of the decision as expeditiously as the Member’s health condition requires, or at least orally, within two (2) Business Days of receiving the request, unless additional information is needed. If no additional information is needed, the PH-MCO must mail written notice of the decision to the Member, the Member’s PCP, and the prescribing Provider within two (2) Business Days after the decision is made. The PH-MCO may make notification Notification of coverage approvals may also be made via electronic notices as permitted under 28 Pa. Code 9.753(b). If additional information is needed to make a decision, the PH-MCO must request such information from the appropriate Provider within forty-eight (48) hours of receiving the request and allow fourteen (14) days for the Provider to submit the additional information. If the PH-MCO requests additional information, the PH-MCO must notify the Member on the date the additional information is requested, using the templatetemplate supplied by the Department in Exhibit N(7), N(7) Request for Additional Information Letter available in DocushareLetter.

Time Frames for Notice of Decisions. a. The PH-MCO must process each request for Prior Authorization of a service and notify the Member of the decision as expeditiously as the Member’s health condition requires, or at least orally, within two (2) Business Days of receiving the request, unless additional information is needed. If no additional information is needed, the PH-MCO must mail written notice of the decision to the Member, the Member’s PCP, and the prescribing Provider within two (( 2) Business Days after the decision is made. The PH-MCO may make notification of coverage approvals via electronic notices as permitted under 28 Pa. Code 9.753(b). If additional information is needed to make a decision, the PH-MCO must request such information from the appropriate Provider within forty-eight (48) hours of receiving the request and allow fourteen (14) days for the Provider to submit the additional information. If the PH-MCO requests additional information, the PH-MCO must notify the Member on the date the additional information is requested, using the template, N(7) Request for Additional Information Letter available in Docushareon the HealthChoices Intranet site.

Time Frames for Notice of Decisions. a. The PH-MCO must process each request for Prior Authorization of a service and notify the Member of the decision as expeditiously as the Member’s 's health condition requires, or at least orally, within two (2) Business Days of receiving the request, unless additional information is needed. If no additional information is needed, the PH-MCO must mail written notice of the decision to the Member, the Member’s 's PCP, and the prescribing Provider within two (2) Business Days after the decision is made. The PH-MCO may make notification of coverage approvals via electronic notices as permitted under 28 Pa. Code 9.753(b). If additional information is needed to make a decision, the PH-MCO must request such information from the appropriate Provider within forty-eight (48) hours of receiving the request and allow fourteen (14) days for the Provider to submit the additional information. If the PH-MCO requests additional information, the PH-MCO must notify the Member on the date the additional information is requested, using the template, N(7) Request for Additional Information Letter available in Docushare.