Timeframes and Procedures for Denying. All or Part of a Service Authorization Request (A) 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 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 Service Authorization Request. The Contractor shall also notify the requesting Provider, although the notice need not be in writing. (B) The Contractor may extend the timeframe for making the decision by up to an additional 14 calendar days if:
Appears in 10 contracts
Samples: Utah Medicaid Contract, Utah Medicaid Contract, Utah Medicaid Contract
