Common use of Timeframes for Authorization Decisions Clause in Contracts

Timeframes for Authorization Decisions. The Contractor must provide a written Notice of Action to the Enrollee, or their legal representative, if a denial, reduction, termination or suspension occurs based on the Level of Care Guidelines.

Timeframes for Authorization Decisions. 11.4.1 The Contractor must provide a written Notice of Action Determination to the EnrolleeIndividual, or their legal representative, if a denial, reduction, termination or suspension occurs based on the Level of Care Guidelines. The Contractor shall adhere to the requirements set forth in the Notification of Coverage and Authorization Determination subsection of this Contract.

Timeframes for Authorization Decisions. 11.4.1 The Contractor must provide a written Notice of Action Determination to the EnrolleeConsumer, or their legal representative, if a denial, reduction, termination or suspension occurs based on the Level of Care Guidelines. The Contractor shall adhere to the requirements set forth in Section 11.5, Notification of Coverage and Authorization Determination.

Timeframes for Authorization Decisions. 11.4.1 The Contractor must provide a written Notice of Action Determination to the EnrolleeConsumer, or their legal representative, if a denial, reduction, termination or suspension occurs based on the Level of Care Guidelines. The Contractor shall adhere to the requirements set forth in Notification of Coverage and Authorization Determination.