Common use of Timeframes for Medical Authorization Clause in Contracts

Timeframes for Medical Authorization. A. Emergency Care: No Prior Authorization required, following the reasonable person standard to determine that the presenting complaint might be an emergency. B. Post-stabilization: Response to request within 30 minutes or the service is deemed approved in accordance with Title 22 CCR Section 53855 (a), or any future amendments thereto. C. Non-urgent care following an exam in the emergency room: Response to request within 30 minutes or deemed approved. ▇. ▇▇▇▇▇▇▇▇▇▇ review of authorization for treatment regimen already in place: Within five (5) working days or less, consistent with urgency of the Member’s medical condition and in accordance with Health and Safety Code Section 1367.01(h)(3), or any future amendments thereto.

Timeframes for Medical Authorization. A. Emergency Care: No Prior Authorization required, following the reasonable person standard to determine that the presenting complaint might be an emergency. B. Post-stabilization: Response to Upon receipt of an authorization request from a provider of emergency services, Contractor shall render a decision within 30 minutes or the service request is deemed approved in accordance with Title 22 CCR Section 53855 (a), or any future amendments theretoapproved. C. Non-urgent care following an exam in the emergency room: Response to request within 30 minutes or deemed approved. ▇. ▇▇▇▇▇▇▇▇▇▇ review Review of authorization for treatment regimen already in place: Within five (5) working days or less24 hours of the decision, consistent with urgency of the Member’s medical condition and in accordance with Health and Safety Code Section 1367.01(h)(3), or any future amendments thereto. E. Retrospective review: Within 30 calendar days in accordance with Health and Safety Code Section 1367.01(h)(1).