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

Time Frames for Notice of Decisions. a. The CHC-MCO must process each request for Prior Authorization and notify the Participant of the decision as expeditiously as the Participant’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 CHC-MCO must mail written notice of the decision to the Participant, the Participant’s PCP, and the prescribing Provider within two (2) business days after the decision is made. The CHC- 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 CHC-MCO must request such information from the appropriate Provider within two (2) business days of receiving the request and allow fourteen (14) days for the Provider to submit the additional information. If the CHC-MCO requests additional information, the CHC-MCO must notify the Participant on the date the additional information is requested, using the template provided by the Department, Request for Additional Information Letter.

Time Frames for Notice of Decisions. a. The CHC-MCO must process each request for Prior Authorization and notify the Participant of the decision as expeditiously as the Participant’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 CHC-MCO must mail written notice of the decision to the Participant, the Participant’s PCP, and the prescribing Provider within two (2) business days after the decision is made. The CHC- CHC-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 CHC-MCO must request such information from the appropriate Provider within two forty-eight (248) business days hours of receiving the request and allow fourteen (14) days for the Provider to submit the additional information. If the CHC-MCO requests additional information, the CHC-MCO must notify the Participant on the date the additional information is requested, using the template provided by the Department, N(7) Request for Additional Information Letter.

Time Frames for Notice of Decisions. a. The CHC-MCO must process each request for Prior Authorization of a service and notify the Participant of the decision as expeditiously as the Participant’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 CHC-MCO must mail written notice of the decision to the Participant, the Participant’s PCP, and the prescribing Provider within two (2) business days after the decision is made. The CHC- CHC-MCO may make notification of coverage approvals via electronic notices as permitted under 28 Pa. PA Code § §9.753(b). If additional information is needed to make a decision, the CHC-MCO must request such information from the appropriate Provider within two forty-eight (248) business days hours of receiving the request and allow fourteen (14) days for the Provider to submit the additional information. If the CHC-MCO requests additional information, the CHC-MCO must notify the Participant on the date the additional information is requested, using the template provided by the Departmenttemplate, N(7) Request for Additional Information Letter.Letter on the Intranet supporting CHC.‌

Time Frames for Notice of Decisions. a. The CHC-MCO must process each request for Prior Authorization and notify the Participant of the decision as expeditiously as the Participant’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 CHC-MCO must mail written notice of the decision to the Participant, the Participant’s PCP, and the prescribing Provider within two (2) business days after the decision is made. The CHC- 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 CHC-MCO must request such information from the appropriate Provider within two forty-eight (248) business days hours of receiving the request and allow fourteen (14) days for the Provider to submit the additional information. If the CHC-MCO requests additional information, the CHC-MCO must notify the Participant on the date the additional information is requested, using the template provided by the Department, Request for Additional Information Letter.