Common use of Expedited authorization decisions Clause in Contracts

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. 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, 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, Department upon request) a need for additional information and how the extension is in the beneficiary’s interest.

Expedited authorization decisions. a. (i) 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 must make an expedited authorization decision and provide notice as expeditiously as the beneficiary’s 's health condition requires, requires and no later than 72 hours 3 working days after receipt of the request for service. b. (ii) The Contractor may extend the 72-hour 3 working days time period by up to 14 calendar days if the beneficiary requests an extension, or if the Contractor justifies (to the Department, State agency upon request) a need for additional information and how the extension is in the beneficiary’s 's best interest.