Expedited authorization decisions Clause Samples

Expedited authorization decisions a. For cases in which a provider indicates, or the Contractor determines, that following the standard timeframe could seriously jeopardize the beneficiary’s life or health or ability to attain, maintain, or regain maximum function, the Contractor shall make an expedited authorization decision and provide notice as expeditiously as the beneficiary’s health condition requires, and no later than 72 hours after receipt of the request for service. b. The Contractor may extend the 72-hour time period by up to 14 calendar days if the beneficiary requests an extension, or if the Contractor justifies (to the Department, upon request) a need for additional information and how the extension is in the beneficiary’s interest.

Expedited authorization decisions. For timeframes for authorization decisions not described in inpatient authorizations or standard authorizations, or cases in which a provider indicates, or the Contractor determines, that following the timeframe for standard authorization decisions could seriously jeopardize the Individual’s life or health, or ability to attain, maintain, or regain maximum function, the Contractor shall make an expedited authorization decision and provide notice as expeditiously as the Individual’s condition requires. 11.4.3.4.1 The Contractor will make the decision within two (2) calendar days if the information provided is sufficient; or request additional information within one (1) calendar day, if the information provided is not sufficient to approve or deny the request. The Contractor must give the provider two (2) calendar days to submit the requested information and then approve or deny the request within two (2) calendar days. 11.4.3.4.2 The Contractor may extend the expedited time period by up to ten (10) calendar days under the following circumstances: The Individual requests the extension; or The Contractor justifies and documents a need for additional information and how the extension is in the Individual’s interest.

Expedited authorization decisions. For cases in which a provider indicates, or the Contractor determines, that following the standard timeframe could seriously jeopardize the Enrollee’s life or health or ability to attain, maintain, or regain maximum function, the Contractor must make an expedited authorization decision and provide notice as expeditiously as the Enrollee’s health condition requires and no later than three (3) working days after receipt of the request for service.

Expedited authorization decisions. For timeframes for authorization decisions not described in inpatient authorizations or standard authorizations, or cases in which a provider indicates, or the Contractor determines, that following the timeframe for standard authorization decisions could seriously jeopardize the Individual’s life or health, or ability to attain, maintain, or regain maximum function, the Contractor shall make an expedited authorization decision and provide notice as expeditiously as the Individual’s condition requires. 11.4.2.4.1 The Contractor will make the decision within two (2) calendar days if the information provided is sufficient; or request additional information within one (1) calendar day, if the information provided is not sufficient to approve or deny the request. The Contractor must give the provider two

Expedited authorization decisions. 1. The PAHP shall make an expedited authorization decision when the standard authorization timeframe could seriously jeopardize the participant’s life, health, or ability to attain, maintain, or regain maximum function as indicted by a provider or the PAHP. 2. The PAHP must make an expedited authorization decision as expeditiously as the participant’s health condition requires, and no later than 72 hours after the 3. The PAHP may extend the 72 hour time period by up to 14 calendar days if the participant requests an extension, or if the PAHP justifies (to the State agency upon request) a need for additional information and how the extension is in the participant’s interest.