May May ISP and MN/LOC must be corrected to May 22 May 31 June 30* 22 24 June 30. Managed care organization should have submitted an ISP and MN/LOC for June June June June 9 May 31 June 30 1. If forms are not submitted, enter 30 11 Service Group 19/Service Code 13 for June 1 through June 30. *The 10-day adverse action period expires after the end of the month. 3631.4 Unable to Locate Revision 17-1; Effective 1, 2017 Current Date Form Date Individual Form HHSC Service Plan Service Authorization System Action Termination Informed (ISP) End Sent Date Date ISP and Medical Necessity/Level of Care December January May 31 January 31 (MN/LOC) must be corrected to January 31 2 31. May 3 May 31 May 5 May 31 None ISP and MN/LOC must be corrected to June May 5 May 31 May 27 June 30* 30. Managed care organization should have submitted an ISP and MN/LOC for June 1. June 9 May 31 June 11 June 30 If these forms are not submitted, enter Service Group 19/Service Code 13 for June 1 through June 30. *The 10-day adverse action period expires after the end of the month.
May 22 May 22 May 31 May 24 June 30* ISP and MN/LOC must be corrected to June 30. June 30 June 9 May 31 June 11 June 30 Managed care organization should have submitted an ISP and MN/LOC for June 1. If forms are not submitted, enter Service Group 19/Service Code 13 for June 1 through June 30. *The 10-day adverse action period expires after the end of the month. 3631.4 Unable to Locate Revision 17-1; Effective 1, 2017 Date HHSC Informed Current Individual Service Plan (ISP) End Date Date Form Sent Form Termination Date Service Authorization System Action December 31 May 31 January 2 January 31 ISP and Medical Necessity/Level of Care (MN/LOC) must be corrected to January 31. May 3 May 31 May 5 May 31 None May 5 May 31 May 27 June 30* ISP and MN/LOC must be corrected to June 30. June 9 May 31 June 11 June 30 Managed care organization should have submitted an ISP and MN/LOC for June 1. If these forms are not submitted, enter Service Group 19/Service Code 13 for June 1 through June 30. *The 10-day adverse action period expires after the end of the month.
SPH_17-5_Section_3000.docx