Examples of Care Claim in a sentence
Topic #512 Electronic837 TransactionEven if the original claim was submitted on paper, providers may submit electronic adjustment requests using an 837 (837 Health Care Claim) transaction.
The Explanation of Medical Benefits form requirement for paper claims and adjustments is intended to help ensure consistency with electronic claims and adjustments submitted via the ForwardHealth Portal or using an 837 (837 Health Care Claim) transaction (including those submitted using PES (Provider Electronic Solutions) software or through a clearinghouse or software vendor).
The Member may request an expedited appeal of an Urgent Care Claim.
AvMed will notify the Claimant of the benefit determination as soon as possible, taking into account the medical exigencies, but no later than 72 hours after receipt of the Urgent Care Claim.
If a Claim is a Pre-Service or Urgent Care Claim, a Health Professional with knowledge of the Member’s Condition will be permitted to act as the Member’s authorized representative, and will be notified of all approvals on the Member’s behalf.
However, if a Physician with knowledge of the Member’s Condition determines that the Claim is an Urgent Care Claim, it will be deemed urgent.
Submitting a Claim To submit an Extended Health Care claim, you must complete an Extended Health Care Claim form, except when claiming for physician or hospital expenses incurred outside your province of residence.
An appeal of an Adverse Benefit Determination with respect to an Urgent Care Claim may be submitted to AvMed’s Member Engagement Center at the address listed under Appeal of a Pre-Service Claim, above.
A Claimant may appeal an Adverse Benefit Determination with respect to an Urgent Care Claim within 365 days of receiving the Adverse Benefit Determination.
Concurrent Care Claims A Concurrent Care Claim is a special type of Claim that arises if the Plan informs a claimant that benefits for a course of treatment that has been previously approved for a period of time or number of treatments is to be reduced or eliminated.