Common use of Timeframe for Decisions Clause in Contracts

Timeframe for Decisions. The IDT staff shall make decisions on direct requests for services and provide notice as expeditiously as the member’s health condition requires. a. Standard Service Authorization Decisions i. Standard service authorization decisions shall be made no later than fourteen (14) calendar days following receipt of the request for the service unless the MCO extends the timeframe for up to fourteen (14) additional calendar days. If the timeframe is extended, the MCO must send a written notification to the member no later than the fourteenth day after the original request The notification of extension must inform the member that: a) The member may file a grievance if dissatisfied with the extension, in which case the extension will be considered a denial, and b) The member may contact the Member Rights Specialist for assistance.

Timeframe for Decisions. The IDT staff shall make decisions on direct requests for services and provide notice as expeditiously as the member’s health condition requires. a. Standard Service Authorization Decisions i. Standard service authorization decisions shall be made no later than fourteen (14) calendar days following receipt of the request for the service unless the MCO IHCP extends the timeframe for up to fourteen (14) additional calendar days. If the timeframe is extended, the MCO IHCP must send a written notification to the member no later than the fourteenth day after the original request The notification of extension must inform the member that: a) The member may file a grievance with the MCO if dissatisfied with the extension, in which case the extension will be considered a denial, and b) The member may contact the MCO’s Member Rights Specialist for assistance.