Common use of Transplants Clause in Contracts

Transplants. The Health Plan shall ensure that all decisions to deny a service authorization request, or limit a service in amount, duration, or scope that is less than requested, are made by health care professionals who have the appropriate clinical expertise in treating the enrollee’s condition or disease (see 42 CFR 438.210(b)(3)).

Transplants. The Health Plan shall ensure that all decisions to deny a service authorization Service Authorization request, or limit a service in amount, duration, or scope that is less than requested, are made by health care professionals Health Care Professionals who have the appropriate clinical expertise in treating the enrolleeEnrollee’s condition or disease disease. (see See 42 CFR C.F.R. 438.210(b)(3)).