Action means Clause Samples
Action means. (A) the denial or limited authorization of a requested service, including the type or level of service;
(B) the reduction, suspension, or termination of a previously authorized service; the denial, in whole or in part of payment for a service;
(C) the failure to provide services in a timely manner; the failure of the MCO to act within the timeframes defined in sections 8.3 and 8.4; or,
(D) for a resident of a Rural Area with only one MCO, the denial of an Enrollee’s request to exercise his or her right to obtain services outside the network.
Action means. 9.1.1.1 The denial or limited authorization of a requested service, including the type or level of service;
9.1.1.2 The reduction, suspension, or termination of a previously authorized service;
9.1.1.3 The denial, in whole or in part, of payment for a service;
9.1.1.4 The failure to provide services in a timely manner, as defined by the State; and
9.1.1.5 The failure of the Contractor to act within the timeframes provided in §9.7.1.