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.
Appears in 11 contracts
Sources: Medicaid Contract, Medicaid Contract, Utah Medicaid Contract
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 to send out a Notice of Adverse Benefit Determination to the Enrollee and the Provider on the day date that the timeframe expires.
Appears in 10 contracts
Sources: Prepaid Mental Health Plan, Prepaid Mental Health Plan, Prepaid Mental Health Plan Healthy U Behavioral Amendment 9
Service Authorization Decisions Not Reached within Required Timeframes. In the event that the Contractor fails to make a Service Authorization service authorization decision within the prescribed required 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.
Appears in 7 contracts
Sources: Prepaid Mental Health Plan (Pmhp) Contract, Prepaid Mental Health Plan (Pmhp) Contract, Prepaid Mental Health Plan (Pmhp) Contract
Service Authorization Decisions Not Reached within Required Timeframes. In the event that the Contractor fails to make a Service Authorization 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.
Appears in 3 contracts
Sources: Accountable Care Organization (Aco) Contract, Accountable Care Organization (Aco) Contract, Home Program Contract
Service Authorization Decisions Not Reached within Required Timeframes. In the event that the Contractor fails to make a Service Authorization service authorization decision within the prescribed proscribed 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.
Appears in 2 contracts
Sources: Integrated Care Contract, Accountable Care Organization (Aco) Contract