Ariz. Admin. Code § R9-34-225 - Reversed Appeal Resolutions
A. If the contractor or the Director's
Decision reverses a decision to deny, limit, or delay services that were not
furnished while the appeal was pending, the contractor shall authorize or
provide the disputed services promptly, and as expeditiously as the enrollee's
health condition requires.
B. If
the contractor or the Director's Decision reverses a decision to deny
authorization of services, and the enrollee received the disputed services
while the appeal was pending, the contractor shall pay the provider for those
services.
Notes
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