Common use of Authorization Process Clause in Contracts

Authorization Process. The Contractor shall develop a Prior Authorization (PA) process as part of the Dental Management Program that comports with all State and federal requirements. In accordance with 42 C.F.R. § 438.210(b), the Contractor and any applicable Subcontractors shall have in place and follow written policies and procedures for processing requests for initial and continuing authorizations of services. The Contractor’s Prior Authorization process shall also put in place mechanisms to ensure consistent application of review criteria for authorization decisions and consult with the Provider that requested the services when appropriate. The Contractor shall provide information sufficient for OHCA to comply with its statutory responsibilities under 63 O.S. § 2560 – 2565, as requested. OHCA reserves the right to standardize certain parts of the PA reporting process across Dental Benefit Managers, such as requiring Contractors to adopt and apply the same definitions regarding approved, pended, denied, suspended requests, and other policies and processes, as determined by OHCA. The Contractor shall develop plans and processes to monitor Prior Authorization requests and denials. The Contractor shall use this information to identify strategies to address over- and under-utilization of services, sharing monitoring and strategies with OHCA upon request.

Authorization Process. The Contractor shall develop a Prior Authorization (PA) process as part of the Dental Management Program that comports with all State and federal requirements. In accordance with 42 C.F.R. § 438.210(b), the Contractor and any applicable Subcontractors shall have in place and follow written policies and procedures for processing requests for initial and continuing authorizations of services. The Contractor’s Prior Authorization process shall also put in place mechanisms to ensure consistent application of review criteria for authorization decisions and consult with the Provider that requested the services when appropriate. The Contractor shall provide information sufficient for OHCA to comply with its statutory responsibilities under 63 O.S. § 2560 – 2565, as requested. OHCA reserves the right to standardize certain parts of the PA reporting process across Dental Benefit Managers, such as requiring Contractors to adopt and apply the same definitions regarding approved, pended, denied, suspended requests, and other policies and processes, as determined by OHCA▇▇▇▇. The Contractor shall develop plans and processes to monitor Prior Authorization requests and denials. The Contractor shall use this information to identify strategies to address over- and under-utilization of services, sharing monitoring and strategies with OHCA upon request.