5101:6-2-31 State hearings: notice of denial of prior authorization for medical or dental services.

When a request for prior authorization for a medical or dental service is denied, the individual and authorized representative shall be provided prompt written notice of the decision. Copies shall also be sent to the provider and to the local agency.

(A) The notice shall contain a clear and understandable statement of the action taken and the reasons for it, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a state hearing, and contain a telephone number to call about free legal services.

(B) A notice describing the denial of authorization for medical services or its computer-generated equivalent shall be used.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 9/1/76, 4/1/80, 10/1/81, 5/1/82, 7/1/82, 4/1/83, 11/1/83
(Temp), 12/1/83, 1/1/84, 3/1/84 (Temp), 6/1/84, 10/3/84 (Emer), 12/22/84, 4/1/86, 4/1/87, 9/1/87, 7/1/88 (Emer), 9/25/88, 10/1/89, 2/1/90, 4/1/91, 6/1/93, 11/1/94, 6/1/03 , 9/1/08