Denial of Payment for a Service. The MCO must mail or hand deliver written notice of action xxxxx://xxx.xxx.xxxxxxxxx.xxx/familycare/mcos/noa.htm to an affected member when the MCO intends to deny a member’s request for payment of a service included in the benefit package. Although the MCO may pay for a service that is outside of the benefit package under the circumstances set forth in Article VII, Section A.5., an MCO is not required to provide a notice of action when it denies a member’s request for payment of such a service. The MCO is however required to inform members in writing when a request for payment of a service outside of the benefit package is denied. The MCO must utilize DHS’ Notification of Non Covered Benefit template (xxxxx://xxx.xxx.xxxxxxxxx.xxx/forms/f0/f01283.doc) and must maintain a copy of this completed form in the member’s file.
Denial of Payment for a Service. The IHCP must mail or hand deliver written notice of action xxxxx://xxx.xxx.xxxxxxxxx.xxx/familycare/mcos/noa.htm to an affected member when the IHCP intends to deny a member’s request for payment of a service included in the benefit package. Although the IHCP may pay for a service that is outside of the benefit package , an IHCP is not required to provide a notice of action when it denies a member’s request for payment of such a service. The IHCP is however required to inform members in writing when a request for payment of a service outside of the benefit package is denied. The IHCP must utilize DHS’ Notification of Non Covered Benefit template (xxxxx://xxx.xxx.xxxxxxxxx.xxx/forms/f0/f01283.doc) and must maintain a copy of this completed form in the member’s file.
