Processing Pre-Service Claims (Non-Urgent Sample Clauses

Processing Pre-Service Claims (Non-Urgent. A Pre-Service Claim, including a request for pre-authorization, that requires no additional information to process will be approved or denied by the claims administrator no later than 15 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 15-day period may be extended for up to an additional 15 days. The claims administrator will provide written or electronic notice of the extension to the claimant within the initial 15-day period. This notice will specify the circumstances requiring the extension and the date by which the claims administrator expects a decision. If a claimant does not submit sufficient information, the claims administrator will provide the claimant with written or electronic notice of the specific information required to process the claim. Such notice will be provided before the end of the initial 15-day period, and the claimant will have 45 days to provide the required information. In such case, the claims administrator will approve or deny the Pre-Service Claim no more than 15 days following the earlier of: (1) the date the claimant‟s response is received; or (2) the date such 45-day period ends.