Common use of Pursuant to Section 4 Clause in Contracts

Pursuant to Section 4. 11.1, the Contractor shall submit Prior Authorization and Pre-Certification Reports that summarize all requests in the preceding quarter for Prior Authorization and Pre-Certification. The Report shall include, at a minimum, the following information: · Total number of completed requests for Standard Service Authorizations; · Total number of completed requests for Expedited Service Authorizations; · Percent of completed requests within timeliness standards by type of service; · Total number of completed requests authorized by type of service; · Total number or completed requests denied by type of service; and · Percent of completed requests denied by type of service; · Patterns and aggregate trend analysis

Pursuant to Section 4. 11.1, the Contractor shall submit Prior Authorization and Pre-Certification Reports that summarize all requests in the preceding quarter for Prior Authorization and Pre-Certification. The Report shall include, at a minimum, the following information: · • Total number of completed requests for Standard Service Authorizations; · • Total number of completed requests for Expedited Service Authorizations; · • Percent of completed requests within timeliness standards by type of service; · • Total number of completed requests authorized by type of service; · • Total number or completed requests denied by type of service; and · • Percent of completed requests denied by type of service; · • Patterns and aggregate trend analysis