Common use of Procedural Defects Clause in Contracts

Procedural Defects. If a Pre-service Claim submission is not made in accordance with the plan's requirements, Humana will notify the Claimant of the problem and how it may be remedied within five (5) days (or within 24 hours, in the case of an Urgent-care Claim). If a Post-service Claim is not made in accordance with the plan's requirement, it will be returned to the submitter. Authorized Representatives A covered person may designate an authorized representative to act on his or her behalf in pursuing a benefit claim or appeal. The authorization must be in writing and authorize disclosure of health information. If a document is not sufficient to constitute designation of an authorized representative, as determined by Humana, the plan will not consider a designation to have been made. An assignment of benefits does not constitute designation of an authorized representative. • Any document designating an authorized representative must be submitted to Humana in advance or at the time an authorized representative commences a course of action on behalf of the covered person. Humana may verify the designation with the covered person prior to recognizing authorized representative status. • In any event, a health care provider with knowledge of a covered person's medical condition acting in connection with an Urgent-care Claim will be recognized by the plan as the covered person's authorized representative. Covered persons should carefully consider whether to designate an authorized representative. Circumstances may arise under which an authorized representative may make decisions independent of the covered person, such as whether and how to appeal a claim denial.

Procedural Defects. If a Pre-service Claim submission is not made in accordance with the plan's requirements, Humana will notify the Claimant of the problem and how it may be remedied within five (5) days (or within 24 hours, in the case of an Urgent-care Claim). If a Post-service Claim is not made in accordance with the plan's requirement, it will be returned to the submitter. Authorized Representatives representatives A covered person may designate an authorized representative to act on his or her behalf in pursuing a benefit claim claim, an internal appeal or appealan external review. The authorization designation must be in writing and authorize disclosure must be made by the covered person on Humana's Appointment of health information. If Representation (AOR) Form or on a document is not sufficient to constitute designation of an authorized representative, as determined form approved in advance by Humana, the plan will not consider a designation to have been made. An assignment of benefits does not constitute designation of an authorized representative. • Any document designating an authorized representative Humana's AOR Form must be submitted to Humana in advance or at the time or prior to the date an authorized representative commences a course of action on behalf of the covered person. At the same time, the authorized representative should also provide notice of commencement of the action on behalf of the covered person to the covered person, which Humana may verify the designation with the covered person prior to recognizing authorized representative status. • In any event, a health care provider with knowledge of a covered person's medical condition acting in connection with an Urgenturgent-care Claim claim will be recognized by the plan as the covered person's authorized representative. Covered persons should carefully consider whether to designate an authorized representative. Circumstances may arise under which an An authorized representative may make decisions independent of the covered person, such as whether and how to appeal a claim denial.

Procedural Defects. If a Pre-service Claim submission is not made in accordance with the plan's ’s requirements, Humana will notify the Claimant of the problem and how it may be remedied within five (5) days (or within 24 hours, in the case of an Urgent-care Claim). If a Post-service Claim is not made in accordance with the plan's ’s requirement, it will be returned to the submitter. Authorized Representatives A covered person may designate an authorized representative to act on his or her behalf in pursuing a benefit claim or appeal. The authorization must be in writing and authorize disclosure of health information. If a document is not sufficient to constitute designation of an authorized representative, as determined by Humana, the plan will not consider a designation to have been made. An assignment of benefits does not constitute designation of an authorized representative. • Any document designating an authorized representative must be submitted to Humana in advance or at the time an authorized representative commences a course of action on behalf of the covered person. Humana may verify the designation with the covered person prior to recognizing authorized representative status. • In any event, a health care provider with knowledge of a covered person's ’s medical condition acting in connection with an Urgent-care Claim will be recognized by the plan as the covered person's ’s authorized representative. Covered persons should carefully consider whether to designate an authorized representative. Circumstances may arise under which an authorized representative may make decisions independent of the covered person, such as whether and how to appeal a claim denial.