Common Contracts
1 similar Contract for Furnishing Health Services by a Managed Care Organization contracts
CONTRACT FOR FURNISHING HEALTH SERVICES BY A MANAGED CARE ORGANIZATIONContract for Furnishing Health Services by a Managed Care Organization • August 30th, 2022
the denial or limitation of authorization of a requested service; the reduction, suspension, or termination of a previously authorized service; the denial of payment for a service, not including a denial solely because the claim does not meet the definition of a “clean claim” at 42 CFR §447.45(b); the failure to provide services in a timely manner; the failure to respond to an Appeal or Grievance in a timely manner; solely with respect to an MCO that is the only Contractor serving a Rural Area, the denial of an Enrollee’s request to obtain services beyond the travel time and distance standards established for an Enrollee who lives in a Rural Area as set forth in section 5.8.1.1; or, the denial of an Enrollee’s request to dispute a financial liability, including cost sharing.
