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.