Common use of Timeframe for Notice of Action Clause in Contracts

Timeframe for Notice of Action. In accordance with 42 C.F.R.§ 438.404(c), the MCO must mail a notice of Action within the following timeframes: 1. for termination, suspension, or reduction of previously authorized Medicaid-covered services, within the timeframes specified in 42 C.F.R.§§ 431.211, 431.213, and 431.214; 2. for denial of payment, at the time of any Action affecting the claim; 3. for standard service authorization decisions that deny or limit services, within the timeframe specified in 42 C.F.R.§ 438.210(d)(1); 4. if the MCO extends the timeframe in accordance with 42 C.F.R. §438.210(d)(1), it must: a. give the Member written notice of the reason for the decision to extend the timeframe and inform the Member of the right to file an Appeal if he or she disagrees with that decision; and b. issue and carry out its determination as expeditiously as the Member’s health condition requires and no later than the date the extension expires;