Common use of Prior authorization time frames Clause in Contracts

Prior authorization time frames. A. A benefit determination for non- urgent prior authorization requests will be made within fifteen (15) calendar days of the receipt of the request. The fifteen (15) days may be extended by the claims administrator for up to fifteen (15) calendar days if an extension is needed as a result of matters beyond the claims administrator’s control. The claims administrator will notify the member of any necessary extension prior to the expiration of the initial fifteen- (15-) cal- endar-day period. If a member fails to submit necessary information to make a benefit determination, the member will be given at least forty-five (45) calendar days from receipt of the extension notice to respond with additional information. B. A benefit determination for urgent prior authorization requests will be made as soon as possible based on the clinical situa- tion, but in no case later than twenty-four

Prior authorization time frames. A. A benefit determination for non- urgent prior authorization requests will be made within fifteen (15) calendar days of the receipt of the request. The fifteen (15) days may be extended by the claims administrator for up to fifteen (15) calendar days if an extension is needed as a result of matters beyond the claims administrator’s control. The claims administrator will notify the member of any necessary extension prior to the expiration of the initial fifteen- fifteen (15-) cal- endar15)-calen- dar-day period. If a member fails to submit necessary information to make a benefit determination, the member will be given at least forty-five (45) calendar days from receipt of the extension notice to respond with additional information. B. A benefit determination for urgent prior authorization requests will be made as soon as possible based on the clinical situa- tion, but in no case later than twenty-four

Prior authorization time frames. A. A benefit determination for non- urgent prior authorization requests will be made within fifteen (15) calendar days of the receipt of the request. The fifteen (15) days may be extended by the claims administrator for up to fifteen (15) calendar days if an extension exten- sion is needed as a result of matters beyond the claims administrator’s control. The claims administrator will notify the member of any necessary extension prior to the expiration of the initial fifteen- (15-) cal- endarcalendar-day period. If a member fails to submit necessary information informa- tion to make a benefit determination, the member will be given at least forty-five (45) calendar days from receipt of the extension notice to respond with additional information. B. A benefit determination for urgent prior authorization requests will be made as soon as possible based on the clinical situa- tion, but in no case later than twenty-four

Prior authorization time frames. A. A benefit determination for non- urgent prior authorization requests will be made within fifteen (15) calendar days of the receipt of the request. The fifteen (15) days may be extended by the claims administrator for up to fifteen (15) calendar days if an extension is needed as a result of matters beyond the claims administrator’s control. The claims administrator will notify the member of any necessary extension prior to the expiration of the initial fifteen- (15-) cal- endar-day period. If a member fails to submit necessary information to make a benefit determination, the member will be given at least forty-five ninety (4590) calendar days from receipt of the extension notice to respond with additional addition- al information. B. A benefit determination for urgent prior authorization requests will be made as soon as possible based on the clinical situa- tion, but in no case later than twenty-four