Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Post-Service Claim. Any claim for a benefit that is not a pre-service claim.
Concurrent Care Claim Extension. A request to extend a course of treatment previously pre-authorized by HMO.
Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-service claim depending on the circumstances Post-Service Claim. Any claim for a benefit that is not a pre-service claim. 14 calendar days from receipt of the appeal. Review provided by HMO personnel not involved in making the adverse benefit determination.
Concurrent Care Claim Extension. A request to extend a course of treatment previously pre- authorized by HMO. If an urgent care claim, as soon as possible but not later than 24 hours. Otherwise, within 15 calendar days.
Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre- service claim depending on the circumstances Treated like an urgent care claim or a pre- service claim depending on the circumstances Post-Service Claim. Any claim for a benefit that is not a pre-service claim. Within 5 business days Within 15 business days Review provided by HMO personnel not involved in making the adverse benefit determination. Review provided by HMO Appeals Committee. HMO maintains a formal Internal Utilization Management Appeal process (Level Two) whereby any Member or Provider acting on behalf of a Member with the Member’s consent, who is dissatisfied with the results of a Level One Appeal, shall have the opportunity to pursue his or her Appeal before a panel of Physicians and/or other health care professionals selected by HMO who have not been involved in any of the previous utilization management decisions. The Member and/or an authorized representative may attend the Level Two Appeal hearing and question the representatives of HMO and present his/her case.
Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Post-Service Claim. Any claim for a benefit Within 30 calendar days Within 30 calendar days
Concurrent Care Claim Extension. A request to extend a course of treatment previously pre- authorized by HMO. If an urgent care claim, as soon as possible but not later than 24 hours. Otherwise, within 15 calendar days. Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. With enough advance notice to allow the Member to Appeal. Within 30 calendar days. HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO. The procedure the Member needs to follow will depend on the type of issue or problem the Member has. • Appeal. An Appeal is a request to the HMO to reconsider an adverse benefit determination. The Appeal procedure for an adverse benefit determination has two levels. • Complaint. A Complaint is an expression of dissatisfaction about quality of care or the operation of the HMO. The Complaint procedure may, if the Member chooses, follow the same path as an Adverse Benefit Determination.
