Processing Post-Service Claims Sample Clauses

Processing Post-Service Claims. We will use our best efforts to pay, contest, or deny all Post-Service Claims for which we have all of the necessary information, as determined by us, within the timeframes described below.

Processing Post-Service Claims. A Post-Service Claim that requires no additional information to process will be approved or denied by the claims administrator no later than 30 days after receipt. Written or electronic notice of the approval or denial will be given to the claimant by the claims administrator in accordance with Section 17-1 (f) or (g) below. If special circumstances require, the initial 30-day period to decide the Post-Service Claim may be extended for up to an additional 15 days. The claims administrator will provide written or electronic notice of such extension to the claimant before the end of the initial 30-day period. The notice will specify the circumstances requiring the extension and the date by which the claims administrator expects to decide the claim. If a claimant does not submit sufficient information to allow the claims administrator to decide a Post-Service Claim, the claims administrator will provide the claimant with written or electronic notice of the specific information required to decide the claim. Such notice shall be provided before the end of the initial 30-day period, and the claimant will have 45 days to provide the required information. The claims administrator will then approve or deny the Post-Service Claim no more than 15 days following the earlier of: (1) the date the claims administrator receives the claimant‟s response; or (2) the date such 45-day period ends.