A determination made by the LME/MCO in response to a Network Provider’s request for approval to provide in-plan services of a specific duration and scope which:

∙ Disapproves the request completely; or
∙ Approves provision of the requested service(s), but for a lesser scope or duration than requested by the Provider; (an approval of a requested services which includes a requirement for a concurrent review by the LME/MCO during the authorized period does not constitute a denial); or
∙ Disapproves provision of the requested service(s), but approves provision of an alternative service(s).

Page last modified: October 15, 2015
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