Transplants. (e) The Health Plan shall ensure that all decisions to deny a service authorization request, or limit a service in amount, duration, or scope that is less than requested, are made by health care professionals who have the appropriate clinical expertise in treating the enrollee’s condition or disease (see 42 CFR 438.210(b)(3)).
Appears in 3 contracts
Samples: Standard Contract (Wellcare Health Plans, Inc.), Contract (Wellcare Health Plans, Inc.), Attachment (Amerigroup Corp)
Transplants. (e) ii. The Health Plan shall ensure that all decisions to deny a service authorization Service Authorization request, or limit a service in amount, duration, or scope that is less than requested, are made by health care professionals Health Care Professionals who have the appropriate clinical expertise in treating the enrolleeEnrollee’s condition or disease disease. (see See 42 CFR C.F.R. 438.210(b)(3)).
Appears in 2 contracts
Samples: Wellcare Health Plans, Inc., Wellcare Health Plans, Inc.
