Common use of Initial Claim Clause in Contracts

Initial Claim. Post-Service Claims must be submitted to AvMed within 90 days from the date of service or within one year unless the Member was legally incapacitated; otherwise the Claim will be considered to have been waived. 1) Post-Service Claims must include all of the information listed below. If a Claim is for services received to treat an Emergency Medical Condition or an Urgent Medical Condition while outside the continental United States, Alaska or Hawaii, the information must be translated into English. a) The name of the individual who received the services; b) The Member’s name and Member ID number as they appear on the Member Identification Card; c) The place of service and the date of service; d) A description of the services including any applicable procedure codes; e) The diagnosis including any applicable diagnosis codes; f) The provider’s name and address; and g) The amount actually charged by the provider and a copy of the paid receipts; 2) AvMed will notify the Claimant of the benefit determination no later than 30 days after receipt of a Post-Service Claim. AvMed may extend this period one time for up to 15 additional days if we determine such an extension is necessary due to matters beyond our control and we notify the Claimant, before the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which we expect to render a decision. a) If such an extension is necessary because the Claimant failed to provide sufficient information to decide the Claim, the notice of extension will specifically describe the required information, and the Claimant will be afforded at least 45 days from receipt of the notice to provide the specified information. b) XxXxx's period for making the benefit determination will be tolled from the date the notification of the extension is sent to the Claimant, until the date the Claimant responds to the request for additional information. If the Claimant fails to supply the requested information within the 45-day period, the Claim will be denied.

Initial Claim. Post-Service Claims must be submitted to AvMed within 90 days from the date of service or within one year unless the Member was legally incapacitated; otherwise the Claim will be considered to have been waived. 1) Post-Service Claims must include all of the information listed below. If a Claim is for services received to treat an Emergency Medical Condition or an Urgent Medical Condition while outside the continental United States, Alaska or and Hawaii, the information must be translated into English. a) The name of the individual who received the services; b) The Member’s name and Member ID number as they appear on the Member Identification Card; c) The place of service and the date of service; d) A description of the services including any applicable procedure codes; e) The diagnosis including any applicable diagnosis codes; f) The provider’s name and address; and g) The amount actually charged by the provider and a copy of the paid receipts; 2) AvMed will notify the Claimant of the benefit determination no later than 30 days after receipt of a Post-Service Claim. AvMed may extend this period one time for up to 15 additional days if we determine such an extension is necessary due to matters beyond our control and we notify the Claimant, before the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which we expect to render a decision. a) If such an extension is necessary because the Claimant failed to provide sufficient information to decide the Claim, the notice of extension will specifically describe the required information, and the Claimant will be afforded at least 45 days from receipt of the notice to provide the specified information. b) XxXxx's period for making the benefit determination will be tolled from the date the notification of the extension is sent to the Claimant, until the date the Claimant responds to the request for additional information. If the Claimant fails to supply the requested information within the 45-day period, the Claim will be denied.

Initial Claim. Post-Service Claims must be submitted to AvMed within 90 days from the date of service or within one year unless the Member was legally incapacitated; otherwise the such a Claim will be considered to have been waived. 1) Post-Service Claims must include all of the information listed below. If a Claim is for services received to treat an Emergency Medical Condition or an Urgent Medical Condition while outside the continental United States, Alaska or and Hawaii, the information must be translated into English. a) The place of service and the date of service; b) A description of the services including any applicable procedure codes; c) The diagnosis including any applicable diagnosis codes; d) The provider’s name and address; e) The amount actually charged by the provider and a copy of the paid receipts; f) The name of the individual who received the services;; and bg) The Member’s name and Member ID number as they appear on the Member Identification Card; c) The place of service and the date of service; d) A description of the services including any applicable procedure codes; e) The diagnosis including any applicable diagnosis codes; f) The provider’s name and address; and g) The amount actually charged by the provider and a copy of the paid receipts;. 2) AvMed will shall notify the Claimant of the benefit determination no not later than 30 days after receipt of a the Post-Service Claim. . 3) AvMed may extend this period one time for up to 15 additional days days, if we determine such an extension is necessary due to matters beyond our control and we notify the Claimant, Claimant before the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which we expect to render a decision. a) If such an extension is necessary because the Claimant failed to provide sufficient submit the information required to decide the Claim, the notice of extension will shall specifically describe the required information, and the Claimant will shall be afforded at least 45 days from receipt of the notice to provide the specified information. b) XxXxx's period for making the benefit determination will shall be tolled from the date the notification of the extension is sent to the Claimant, until the date the Claimant responds to the request for additional information. . 4) If the Claimant fails to supply the requested information within the 45-day period, the Claim will shall be denied.

Initial Claim. Post-Service Claims must be submitted to AvMed within 90 days from the date of service or within one year unless the Member was legally incapacitated; otherwise the such a Claim will be considered to have been waived. 1) Post-Service Claims must include all of the information listed below. If a Claim is for services received to treat an Emergency Medical Condition or an Urgent Medical Condition while outside the continental United States, Alaska or and Hawaii, the information must be translated into English. a) The place of service and the date of service; b) A description of the services including any applicable procedure codes; c) The diagnosis including any applicable diagnosis codes; d) The provider’s name and address; e) The amount actually charged by the provider and a copy of the paid receipts; f) The name of the individual who received the services;; and bg) The Member’s name and Member ID number as they appear on the Member Identification Card; c) The place of service and the date of service; d) A description of the services including any applicable procedure codes; e) The diagnosis including any applicable diagnosis codes; f) The provider’s name and address; and g) The amount actually charged by the provider and a copy of the paid receipts;. 2) AvMed will shall notify the Claimant of the benefit determination no not later than 30 days after receipt of a the Post-Service Claim. . 3) AvMed may extend this period one time for up to 15 additional days if we determine such an extension is necessary due to matters beyond our control and we notify the Claimant, Claimant before the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which we expect to render a decision. a) If such an extension is necessary because the Claimant failed to provide sufficient submit the information required to decide the Claim, the notice of extension will shall specifically describe the required information, and the Claimant will shall be afforded at least 45 days from receipt of the notice to provide the specified information. b) XxXxx's period for making the benefit determination will shall be tolled from the date the notification of the extension is sent to the Claimant, until the date the Claimant responds to the request for additional information. . 4) If the Claimant fails to supply the requested information within the 45-day period, the Claim will shall be denied.

Initial Claim. Post-Service Claims must be submitted to AvMed within 90 days from the date of service or within one year unless the Member was legally incapacitated; otherwise the Claim will be considered to have been waived. 1) Post-Service Claims must include all of the information listed below. If a Claim is for services received to treat an Emergency Medical Condition or an Urgent Medical Condition while outside the continental United States, Alaska or Hawaii, the information must be translated into English. a) The name of the individual who received the services; b) The Member’s name and Member ID number as they appear on the Member Identification Card; c) The place of service and the date of service; d) A description of the services including any applicable procedure codes; e) The diagnosis including any applicable diagnosis codes; f) The provider’s name and address; and g) The amount actually charged by the provider and a copy of the paid receipts; 2) AvMed will notify the Claimant of the benefit determination no later than 30 days after receipt of a Post-Service Claim. AvMed may extend this period one time for up to 15 additional days if we determine such an extension is necessary due to matters beyond our control and we notify the Claimant, before the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which we expect to render a decision. a) If such an extension is necessary because the Claimant failed to provide sufficient information to decide the Claim, the notice of extension will specifically describe the required information, and the Claimant will be afforded at least 45 days from receipt of the notice to provide the specified information. b) XxXxxAvMed's period for making the benefit determination will be tolled from the date the notification of the extension is sent to the Claimant, until the date the Claimant responds to the request for additional information. If the Claimant fails to supply the requested information within the 45-day period, the Claim will be denied.

Initial Claim. Post-Service Claims must be submitted to AvMed within 90 days from the date of service or within one year unless the Member was legally incapacitated; otherwise the Claim will be considered to have been waived. 1) Post-Service Claims must include all of the information listed below. If a Claim is for services received to treat an Emergency Medical Condition or an Urgent Medical Condition while outside the continental United States, Alaska or and Hawaii, the information must be translated into English. a) The name of the individual who received the services; b) The Member’s name and Member ID number as they appear on the Member Identification Card; c) The place of service and the date of service; d) A description of the services including any applicable procedure codes; e) The diagnosis including any applicable diagnosis codes; f) The provider’s name and address; and g) The amount actually charged by the provider and a copy of the paid receipts; 2) AvMed will notify the Claimant of the benefit determination no later than 30 days after receipt of a Post-Service Claim. AvMed may extend this period one time for up to 15 additional days if we determine such an extension is necessary due to matters beyond our control and we notify the Claimant, before the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which we expect to render a decision. a) If such an extension is necessary because the Claimant failed to provide sufficient information to decide the Claim, the notice of extension will specifically describe the required information, and the Claimant will be afforded at least 45 days from receipt of the notice to provide the specified information. b) XxXxx's period AvMex'x xeriod for making the benefit determination will be tolled from the date the notification of the extension is sent to the Claimant, until the date the Claimant responds to the request for additional information. If the Claimant fails to supply the requested information within the 45-day period, the Claim will be denied.