For denial of expedited authorization decisions Sample Clauses

For denial of expedited authorization decisions. In cases in which a provider indicates to the TPA/HCO that following the standard timeframe could seriously jeopardize the enrollee’s life or health, or ability to attain, maintain, or regain maximum function, the TPA/HCO shall 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. If the enrollee, or the provider, or the TPA/HCO justifies a need for additional information or if it is in the best interest of the enrollee, an extension up to 14 additional calendar days may be granted. The TPA/HCO agrees fully to cooperate with the Advisory Committee of the Commonwealth’s Medicaid Office set up as requested by 42 Code of Federal Regulations Part 431, which advises the Medicaid agency about health and medical care services. The ADMINISTRATION and the TPA shall coordinate any and all efforts geared at cooperating with said Advisory Committee to the extent permissible by law.
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For denial of expedited authorization decisions. For cases in which a provider indicates, or INSURER determines, that following the standard timeframe could seriously jeopardize the enrollee’s life, or health, or ability to attain; maintain; or regain maximum function, INSURER shall 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. INSURER may extend said three-day period up to fourteen (14) calendar days if the enrollee requests an extension, or if the entity justifies (to the ADMINISTRATION upon request) the need for additional information and how the extension would be in the enrollee’s best interest.
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Related to For denial of expedited authorization decisions

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  • PROCEDURE FOR APPROVAL OF SETTLEMENT Acceptance of this Settlement Agreement shall be sought at a hearing of the Central Regional Council of the MFDA on a date agreed to by counsel for Staff and the Respondent.

  • PURPOSE/JUSTIFICATION OF RECOMMENDED ACTION The purpose of the Agreement is to provide the City with the services of one senior criminalist from the Department to perform DNA testing, analysis, and forensic-related consulting as requested by the City, effective upon execution by the Board through June 30, 2015. This Agreement will result in the creation of an additional senior criminalist position. The senior criminalist will be assigned solely to the Santa ▇▇▇▇▇▇ Police Department (SMPD).

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  • Final Approval After Acceptance, Engineer shall perform any required modifications, changes, alterations, corrections, redesigns, and additional work necessary to receive Final Approval by the County. "Final Approval" in this sense shall mean formal recognition that the Engineering Services have been fully carried out.