Common use of Service Authorization Decisions Not Reached Within Required Timeframes Clause in Contracts

Service Authorization Decisions Not Reached Within Required Timeframes. In the event that the Contractor fails to make a Service Authorization decision within the prescribed timeframes, such failure shall constitute a denial of services and shall be considered an Adverse Benefit Determination. The Contractor is required send out a Notice of Adverse Benefit Determination to the Enrollee and the Provider on the day that the timeframe expires.

Service Authorization Decisions Not Reached Within Required Timeframes. In the event that the Contractor fails to make a Service Authorization service authorization decision within the prescribed required timeframes, such failure shall constitute a denial of services and shall be considered an Adverse Benefit Determination. The Contractor is required send out a Notice of Adverse Benefit Determination to the Enrollee and the Provider on the day that the timeframe expires.

Service Authorization Decisions Not Reached Within Required Timeframes. In the event that the Contractor fails to make a Service Authorization service authorization decision within the prescribed timeframes, such failure shall constitute a denial of services and shall be considered an Adverse Benefit Determination. The Contractor is required send out a Notice of Adverse Benefit Determination to the Enrollee and the Provider on the day that the timeframe expires.

Service Authorization Decisions Not Reached Within Required Timeframes. In the event that the Contractor fails to make a Service Authorization service authorization decision within the prescribed proscribed timeframes, such failure shall constitute a denial of services and shall be considered an Adverse Benefit Determination. The Contractor is required send out a Notice of Adverse Benefit Determination to the Enrollee and the Provider on the day that the timeframe expires.