Service Authorization. 9.1. CONTRACTOR will collaborate with COUNTY to complete authorization requests in line with COUNTY and DHCS policy.
Service Authorization. A. Contractor shall implement mechanisms to assure authorization decision standards are met. The Contractor shall:
Service Authorization. CalOptima shall provide a written authorization process for County Services pursuant to CalOptima Policies.
Service Authorization. Provider shall comply with the Authorization procedures and requirements set forth in the Provider Manual and this Section 2.3. Provider understands and agrees that, except in the case of Emergency Services, Medically Necessary post- stabilization care services deemed Authorized pursuant to Section 1300.71.4(b)(2) of Title 28 of the California Code of Regulations, or as otherwise provided in the Provider Manual, Provider Services must be Authorized in advance by Blue Shield or its delegate in order for Provider to be eligible for payment hereunder. Blue Shield will not retroactively deny Provider’s claims on the basis of Medical Necessity for services reviewed and Authorized pursuant to the Quality Improvement and Utilization Management Program, provided that Provider submitted full and accurate information to Blue Shield for review under its Quality Improvement and Utilization Management Program. If Provider fails to obtain Authorization prior to providing Provider Services to a Member, as required, or if Provider provides services outside of the scope of the Authorization obtained, then Blue Shield, or its delegate, shall have no obligation to compensate Provider for such services; Provider will be deemed to have waived payment for such services and shall not seek payment from Blue Shield, its delegate, or the Member.
Service Authorization. A. The Contractor may not require prior authorization for Physician, Chiropractor, CRNP, and Respiratory Care services but may require that these services require a referral from the Participant's PCP. The Contractor shall prior authorize all other Capitation Services, in accordance with the practice guidelines for authorization decisions developed as specified in Section 2.1.Z and the procedures in this Section.
Service Authorization. A. Contractor shall implement mechanisms to assure authorization decision standards are met in accordance with Mental Health and Substance Use Disorder Services (MHSUDS) Information Notice 19-026, or any subsequent Departmental notices issued to address parity in mental health and substance use disorder benefits subsequent to the effective date of this contract, and any applicable state and federal regulations. (42 C.F.R. § 438.910(d).) The Contractor shall:
Service Authorization. 19.1 Contractor will collaborate with County to complete authorization requests in line with County and DHCS policy and Contract Exhibit A. [BHRS-77: Substance Use Residential Authorization]
Service Authorization. The Contractor may place limits on a service in accordance with federal regulations and requirements of this Contract as set forth in this section and Section 30.1 “
Service Authorization. The Managed Care Plan’s approval for services to be rendered. The process of authorization must at least include an enrollee’s or a provider’s request for the provision of a service.
Service Authorization. Provider will receive a signed Client Services Authorization Form indicating the number of authorized regular shift rate service hours allowed per month. Services will not be reimbursed without signed authorization prior to such being provided. Any hours for Services the Provider provides to a Client in addition to the number of hours specified on the Client Services Authorization Form shall be considered unauthorized hours. Unauthorized hours will not be reimbursed.
