Complete Claim definition

Complete Claim means a claim for benefits for a Covered Person that has been submitted by a licensed Health Care Provider or the Covered Person, void of any omissions of pertinent information, coordination of benefits or liability issues, in a form satisfactory to TPA and with sufficient documentation to substantiate the claim for benefits under the Plan that is necessary or required according to industry standards or requirements in order for the TPA to make a determination of benefits under the Plan.

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Complete Claim means a Benefits claim for which MHHSI has been provided with all information necessary to process the claim.

Complete Claim means a written or electronic request for payment submitted on the most current editions of the CMS-approved Form 1500 and/or CMS Form UB92, or their successor forms, as identified by the Department of Insurance, Regulation 48, “Health Insurance Standardized Claim Forms” and which is accurate and complete and as to which request for payment there is no material issue regarding Payor’s obligation to pay under the terms of a Health Plan.

Examples of Complete Claim in a sentence

• Any amount owing to Practitioner from Payor under this Agreement after Payor receives a Complete Claim from Practitioner shall be paid within the time period set forth in the applicable Program Attachment of which Participant and OhioHealthy are signatories, taking into consideration any requests from OhioHealthy, the applicable Payor, or their designees for additional information and whether or not the claim involves coordination of benefits.

• For a complete description of all the information that must be included in a Complete Claim refer to the applicable Program Manual.

• In accordance with the terms of the Plan Document and this Agreement, MHHSI will process and pay each Complete Claim in accordance with Exhibit A.

• When all necessary documents and Claim information have been received to constitute a Complete Claim and the Complete Claim has been approved, a Claim check or draft will be remitted on the next Paid Claims batch disbursal date provided that the Plan Sponsor has provided funds for such Complete Claims or advance funding has been provided by the Stop Loss or Excess Loss insurance company.

• The TPA will process Claims or request additional information in order to be able to process a Complete Claim within an average of fourteen (14) Working Days from the date the Complete Claim is received by the TPA.

More Definitions of Complete Claim

Complete Claim means a claim form that contains essential data elements listed in North Carolina’s prompt payment statue to reasonably enable the Payor or designee, as appropriate, to process the request for payment; a Complete Claim may be paper or a mutually acceptable electronic format.

Complete Claim means a claim that contains all of the necessary information and supporting documentation, if applicable, to render a decision on the claim and is submitted within the prescribed timeframe under the Plan’s reasonable claims procedures.

Complete Claim means a claim for benefits for a Covered Person that has been submitted by a licensed Health Care Provider or the Covered Person, void of any omissions of pertinent information, coordination of

Complete Claim means, unless applicable law otherwise requires, an accurate Claim submitted pursuant to this Agreement, for which all information necessary to process such Claim and make a benefit determination is included.

Complete Claim means a claim or portion thereof, if separable, including attachments and supplemental information or documentation, which provides “reasonably relevant information” as defined by Section 1300.71(a)(10) of Title 28 of the California Code of Regulations “information necessary to determine payor liability” as further defined in section (a)(11).

Complete Claim means a claim or portion thereof, if separable, including attachments and supplemental information or documentation, which provides: “reasonably relevant information” as defined by section (a)(10) “ information necessary to determine payor liability” as defined in section (a)(11).

Complete Claim means a claim for benefits for a Covered Person that has been submitted by a licensed Health Care Provider or the Covered Person, void of any omissions of pertinent information, coordination of benefits or liability issues, in a form satisfactory to TPA