Common use of Initial Claim Clause in Contracts

Initial Claim. Generally, the determination of whether a Claim is an Urgent Care Claim will be made by an individual acting on behalf of XxXxx, applying the judgment of a prudent layperson possessing an average knowledge of health and medicine. However, if a Physician with knowledge of the Member’s Condition determines that the Claim is an Urgent Care Claim, it will be deemed urgent. Urgent Care Claims may be made orally or in writing. AvMed will notify the Claimant of the benefit determination as soon as possible, taking into account the medical exigencies, but no later than 72 hours after receipt of the Urgent Care Claim. 1) If the Claimant fails to provide sufficient information to determine whether or to what extent benefits are covered or payable under this Contract, AvMed will notify the Claimant, no later than 24 hours after receipt of the Claim, of the specific information necessary to complete the Claim. The Claimant will be afforded no less than 48 hours, to provide the specified information. 2) AvMed will notify the Claimant of the benefit determination no later than 48 hours after the earlier of: XxXxx’s receipt of the specified information, or the end of the period afforded the Claimant to provide the specified information. If the Claimant fails to supply the specified information within the 48-hour period, the Claim will be denied. 3) AvMed may notify the Claimant of the benefit determination orally or in writing. If the notification is provided orally, a written or electronic notification will also be provided to the Claimant no later than three days after the oral notification.

Initial Claim. Generally, the determination of whether a Claim is an Urgent Care Claim will shall be made by an individual acting on behalf of XxXxx, AvMed applying the judgment of a prudent layperson possessing an average knowledge of health and medicine. However, if a Physician with knowledge of the Member’s Condition determines that the Claim is an Urgent Care Claim, it will shall be deemed urgent. Urgent Care Claims may be made orally or in writing. . 1) AvMed will shall notify the Claimant of the benefit determination as soon as possible, taking into account the medical exigencies, but no not later than 72 hours after receipt of the Urgent Care Claim. 1) If , unless the Claimant fails to provide sufficient information to determine whether or to what extent benefits are covered or payable under this Contract. 2) If such information is not provided, AvMed will shall notify the Claimant, no Claimant not later than 24 hours after receipt of the Claim, of the specific information necessary to complete the Claim. The Claimant will shall be afforded no not less than 48 hours, to provide the specified information. 2a) AvMed will shall notify the Claimant of the benefit determination no later than 48 hours after the earlier of: : i) XxXxx’s receipt of the specified information, or ; or ii) the end of the period afforded the Claimant to provide the specified additional information. . b) If the Claimant fails to supply the specified information within the 48-hour period, the Claim will shall be denied. 3) AvMed may notify the Claimant of the benefit determination orally or in writing. If the notification is provided orally, a written or electronic notification will shall also be provided to the Claimant no later than three days after the oral notification.

Initial Claim. Generally, the determination of whether a Claim is an Urgent Care Claim will shall be made by an individual acting on behalf of XxXxx, AvMed applying the judgment of a prudent layperson possessing an average knowledge of health and medicine. However, if a Physician with knowledge of the Member’s Condition determines that the Claim is an Urgent Care Claim, it will shall be deemed urgent. Urgent Care Claims may be made orally or in writing. . 1) AvMed will shall notify the Claimant of the benefit determination as soon as possible, taking into account the medical exigencies, but no not later than 72 hours after receipt of the Urgent Care Claim. 1) If , unless the Claimant fails to provide sufficient information to determine whether or to what extent benefits are covered or payable under this Contract. 2) If such information is not provided, AvMed will shall notify the Claimant, no Claimant not later than 24 hours after receipt of the Claim, of the specific information necessary to complete the Claim. The Claimant will shall be afforded no not less than 48 hours, hours to provide the specified information. 2a) AvMed will shall notify the Claimant of the benefit determination no later than 48 hours after the earlier of: : i) XxXxx’s receipt of the specified information, or ; or ii) the end of the period afforded the Claimant to provide the specified additional information. . b) If the Claimant fails to supply the specified information within the 48-hour period, the Claim will shall be denied. 3) AvMed may notify the Claimant of the benefit determination orally or in writing. If the notification is provided orally, a written or electronic notification will shall also be provided to the Claimant no later than three days after the oral notification.

Initial Claim. Generally, the determination of whether a Claim is an Urgent Care Claim will shall be made by an individual acting on behalf of XxXxx, AvMed applying the judgment of a prudent layperson possessing an average knowledge of health and medicine. However, if a Physician with knowledge of the Member’s Condition determines that the Claim is an Urgent Care Claim, it will shall be deemed urgent. Urgent Care Claims may be made orally or in writing. . 1) AvMed will shall notify the Claimant of the benefit determination as soon as possible, taking into account the medical exigencies, but no not later than 72 hours after receipt of the Urgent Care Claim. 1) If , unless the Claimant fails to provide sufficient information to determine whether or to what extent benefits are covered or payable under this Contractthe Plan. 2) If such information is not provided, AvMed will shall notify the Claimant, no Claimant not later than 24 24-hours after receipt of the Claim, of the specific information necessary to complete the Claim. The Claimant will shall be afforded no not less than 48 hours, to provide the specified information. 2a) AvMed will shall notify the Claimant of the benefit determination no later than 48 hours after the earlier of: : i) XxXxx’s receipt of the specified information, or ; or ii) the end of the period afforded the Claimant to provide the specified additional information. . b) If the Claimant fails to supply the specified information within the 48-hour period, the Claim will shall be denied. 3) AvMed may notify the Claimant of the benefit determination orally or in writing. If the notification is provided orally, a written or electronic notification will shall also be provided to the Claimant Claimant, no later than three days after the oral notification.

Initial Claim. Generally, the determination of whether a Claim is an Urgent Care Claim will be made by an individual acting on behalf of XxXxxAvMex, applying xxplying the judgment of a prudent layperson possessing an average knowledge of health and medicine. However, if a Physician with knowledge of the Member’s Condition determines that the Claim is an Urgent Care Claim, it will be deemed urgent. Urgent Care Claims may be made orally or in writing. AvMed will notify the Claimant of the benefit determination as soon as possible, taking into account the medical exigencies, but no later than 72 hours after receipt of the Urgent Care Claim. 1) If the Claimant fails to provide sufficient information to determine whether or to what extent benefits are covered or payable under this Contract, AvMed will notify the Claimant, no later than 24 hours after receipt of the Claim, of the specific information necessary to complete the Claim. The Claimant will be afforded no less than 48 hours, to provide the specified information. 2) AvMed will notify the Claimant of the benefit determination no later than 48 hours after the earlier of: XxXxx’s AvMex’x receipt of the specified information, or the end of the period afforded the Claimant to provide the specified information. If the Claimant fails to supply the specified information within the 48-hour period, the Claim will be denied. 3) AvMed may notify the Claimant of the benefit determination orally or in writing. If the notification is provided orally, a written or electronic notification will also be provided to the Claimant no later than three days after the oral notification.

Initial Claim. Generally, the determination of whether a Claim is an Urgent Care Claim will shall be made by an individual acting on behalf of XxXxx, AvMed applying the judgment of a prudent layperson possessing an average knowledge of health and medicine. However, if a Physician with knowledge of the Member’s Condition determines that the Claim is an Urgent Care Claim, it will shall be deemed urgent. Urgent Care Claims may be made orally or in writing. . 1) AvMed will shall notify the Claimant of the benefit determination as soon as possible, taking into account the medical exigencies, but no not later than 72 hours after receipt of the Urgent Care Claim. 1) If , unless the Claimant fails to provide sufficient information to determine whether or to what extent benefits are covered or payable under this Contract. 2) If such information is not provided, AvMed will shall notify the Claimant, no Claimant not later than 24 hours after receipt of the Claim, of the specific information necessary to complete the Claim. The Claimant will shall be afforded no not less than 48 hours, hours to provide the specified information. 2a) AvMed will shall notify the Claimant of the benefit determination no later than 48 hours after the earlier of: : i) XxXxx’s receipt of the specified information, or ; or ii) the end of the period afforded the Claimant to provide the specified additional information. . b) If the Claimant fails to supply the specified information within the 48-hour period, the Claim will shall be denied. 3) AvMed may notify the Claimant of the benefit determination orally or in writing. If the notification is provided orally, a written or electronic notification will shall also be provided to the Claimant Claimant, no later than three days after the oral notification.

Initial Claim. Generally, the determination of whether a Claim is an Urgent Care Claim will be made by an individual acting on behalf of XxXxxAvMed, applying the judgment of a prudent layperson possessing an average knowledge of health and medicine. However, if a Physician with knowledge of the Member’s Condition determines that the Claim is an Urgent Care Claim, it will be deemed urgent. Urgent Care Claims may be made orally or in writing. AvMed will notify the Claimant of the benefit determination as soon as possible, taking into account the medical exigencies, but no later than 72 hours after receipt of the Urgent Care Claim. 1) If the Claimant fails to provide sufficient information to determine whether or to what extent benefits are covered or payable under this Contract, AvMed will notify the Claimant, no later than 24 hours after receipt of the Claim, of the specific information necessary to complete the Claim. The Claimant will be afforded no less than 48 hours, to provide the specified information. 2) AvMed will notify the Claimant of the benefit determination no later than 48 hours after the earlier of: XxXxx’s receipt of the specified information, or the end of the period afforded the Claimant to provide the specified information. If the Claimant fails to supply the specified information within the 48-hour period, the Claim will be denied. 3) AvMed may notify the Claimant of the benefit determination orally or in writing. If the notification is provided orally, a written or electronic notification will also be provided to the Claimant no later than three days after the oral notification.