Service Authorization Decisions Not Reached within Required Timeframes Sample Clauses

This clause establishes procedures for situations where decisions regarding service authorization are not made within the timeframes specified by the agreement or applicable regulations. In practice, it may require the service provider to notify the affected party of the delay, provide interim services, or treat the lack of a timely decision as a denial that can be appealed. The core function of this clause is to protect the rights of individuals awaiting service authorization by ensuring timely action or recourse if deadlines are missed, thereby preventing indefinite delays and promoting accountability.
Service Authorization Decisions Not Reached within Required Timeframes. In the event that the Contractor fails to make a Service Authorization decision within the prescribed timeframes, such failure shall constitute a denial of services and shall be considered an Adverse Benefit Determination. The Contractor is required send out a Notice of Adverse Benefit Determination to the Enrollee and the Provider on the day that the timeframe expires.
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Related to Service Authorization Decisions Not Reached within Required Timeframes

  • Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion First Tier Participants: a. The prospective first tier participant certifies to the best of its knowledge and belief, that it and its principals: (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency; (2) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (a)(2) of this certification; and (4) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. b. Where the prospective participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.