Common use of Initial Claim Clause in Contracts

Initial Claim. AvMed will notify the Claimant of the benefit determination with respect to a Pre-Service Claim no later than 15 days after receipt of the Claim. AvMed may extend this period one time for up to 15 additional days, if we determine that such an extension is necessary due to matters beyond our control, and we notify the Claimant before the expiration of the initial 15-day period, of the circumstances requiring the extension of time and the date by which we expect to render a decision. 1) 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. 2) In the case of a failure by a Claimant to follow AvMed's procedures for filing a Pre- Service Claim, the Claimant will be notified of the failure and the proper procedures to be followed, no later than five days following such failure. 3) 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. AvMed will notify the Claimant of the benefit determination with respect to a Pre-Service Claim no later than 15 days after receipt of the Claim. AvMed may extend this period one time for up to 15 additional days, if we determine that such an extension is necessary due to matters beyond our control, and we notify the Claimant before the expiration of the initial 15-day period, of the circumstances requiring the extension of time and the date by which we expect to render a decision. 1) 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. 2) In the case of a failure by a Claimant to follow AvMed's procedures for filing a Pre- Service Claim, the Claimant will be notified of the failure and the proper procedures to be followed, no later than five days following such failure. 3) 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. 1) AvMed will shall notify the Claimant of the benefit determination with respect to a Pre-Service Claim no not later than 15 days after receipt of the Claim. . 2) AvMed may extend this period one time for up to 15 additional days, if we determine that such an extension is necessary due to matters beyond our control, and we notify the Claimant before the expiration of the initial 15-day period, of the circumstances requiring the extension of time and the date by which we expect to render a decision. 1a) 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. 2b) In the case of a failure by a Claimant to follow AvMed's procedures for filing a Pre- Service Claim, the Claimant will shall be notified of the failure and the proper procedures to be followed, no not later than five days following such failure. 3c) 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. . 3) If the Claimant fails to supply the requested information within the 45-day period, the Claim will shall be denied.

Initial Claim. AvMed will notify the Claimant of the benefit determination with respect to a Pre-Service Claim no later than 15 days after receipt of the Claim. AvMed may extend this period one time for up to 15 additional days, if we determine that such an extension is necessary due to matters beyond our control, and we notify the Claimant before the expiration of the initial 15-day period, of the circumstances requiring the extension of time and the date by which we expect to render a decision. 1) 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. 2) In the case of a failure by a Claimant to follow AvMed's procedures for filing a Pre- Service Claim, the Claimant will be notified of the failure and the proper procedures to be followed, no later than five days following such failure. 3) 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.