Concurrent Care Decision definition
Examples of Concurrent Care Decision in a sentence
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Concurrent Care Decision means a decision by Capital Health Plan with respect to an extension of an ongoing course of treatment over a period of time or a number of treatments, if Capital Health Plan had previously approved or authorized in writing coverage, benefits, or payment for that course of treatment or number of treatments.
As defined herein, a Concurrent Care Decision shall not include any decision to deny, reduce, or terminate coverage, benefits, or payment under the Case Management subsection as described in the Coverage Access Rules section of this Member Handbook.
A Concurrent Care Decision is a decision by the Plan to reduce, terminate, or refuse to extend an ongoing course of treatment (for which pre-approval is required and was previously granted) which is to be provided over a specified period of time or for a specified number of treatments.
As defined herein, a Concurrent Care Decision shall not include any decision to deny, reduce, or terminate coverage, benefits, or payment under the Case Management subsection as described in the Coverage Access Rules section of this Certificate of Coverage.
Although a Claimant is strongly encouraged to file any Appeal of an Adverse Benefit Determination on a Concurrent Care Decision as soon as possible, the Claimant shall have up to 180 days following his/her Receipt of the Adverse Benefit Determination to file the Appeal.
Concurrent Care Decision means a decision by Capital Health Plan with respect to an extension of an ongoing course of treatment over a period of time or number of treatments, if Capital Health Plan had previously approved or authorized in writing coverage, benefits, or payment for that course of treatment or number of treatments.
Concurrent Care Decision: If HPN has approved an ongoing course of treatment to be provided over a period of time or number of treatments and reduces or terminates coverage of such course of treatment (other than by Plan amendment or termination) before the end of such period of time or number of treatments, HPN will notify the Member at a time sufficiently in advance of the reduction or termination to allow the Member to appeal and obtain a determination before the benefit is reduced or terminated.
If the Benefit Determination is provided verbally, it will be followed in writing no later than three days after the verbal notice.If the Urgent Preservice Claim involves a Concurrent Care Decision, notice of the Benefit Determination will be provided as soon as possible but no later than 24 hours afterreceipt of your claim for extension of treatment or care, as long as the claim is made at least 24 hours before the prescribed period of time expires or the prescribed number of treatments ends.
In the case of Pre- Service Claim or a Concurrent Care Decision the Board (or its designee) will notify the Claimant of its decision on the appeal no later than 30 days after receipt of the appeal.