Incomplete Claim definition

Incomplete Claim means a claim which, if properly corrected to completion, may be compensable for the covered procedure, but lacks important or material elements which prevent payment of the claim. Incomplete Claims shall be denied if not cured within 30 days of notice of the lack of completeness. Incomplete Claims shall be required to be completed within one year of the date of service being billed.
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Incomplete Claim means a claim that is denied for the purpose of obtaining additional information from the provider. The managed care organization shall pay or deny 95 percent of clean claims within 30 days of receipt, or receipt of additional information. The managed care organization shall pay 99 percent of clean claims within 90 days of receipt.
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Incomplete Claim means a claim that is denied for the purpose of obtaining additional information from the Provider.
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Examples of Incomplete Claim in a sentence

  • Type of Claim Claim Procedures and Appeal ProcessImproper or Incomplete Claim A claim that does not include enough information for us to make a determination.Step 1:The plan has 30 days after receiving your claim to notify you of its decision.

  • If any information needed to process a Claim is missing, the Claim shall be treated as an Incomplete Claim.

  • For Urgent Care Claims, the following time frame applies concerning review and notification concerning the benefit determination: 1) Notification Concerning Incomplete Claim – In the event the Covered Person, or Provider on behalf of the Covered Person, fails to submit complete information in connection with an Urgent Care Claim, the Covered Person or Provider will be notified of the specific information needed to complete the claim within twenty-four(24) hours.

  • The Settlement Administrator shall advise, in writing, any Settlement Class Member who fails to submit all information, documents, or photographs required by the Claim Form and this Agreement and request the Settlement Class Member to supply the missing information, documents, or photographs, by sending the Settlement Class Member a Notice of Incomplete Claim, in the form attached hereto as Exhibit J.

  • If an Urgent Care Claim is incomplete, BCBSF or Aetna shall notify the Claimant as soon as possible, but no later than 24 hours following the Plan’s receipt of the Incomplete Claim.

  • Claimant Makes Initial Incomplete Claim RequestWithin not more than 24 hours (and as soon as possible considering the urgency of the medical situation), Plan notifies Claimant of information needed to complete the claim request.

  • If an extension is necessary, the claimant will be notified before the end of the initial 15-day period of the circumstances requiring the extension and the date by which the Fund expects to render a decision.If an extension is needed because the Fund needs additional information from the claimant on an Incomplete Claim, the extension notice will specify the information needed.

  • If you fail to submit information necessary for the Fund to decide a claim, the period for making the benefit determination shall be tolled from the date on which the Fund sends you the notification of the extension until the date you respond to the request for additional information.If an extension is required because the claimant submits an Incomplete Claim, the notice will also describe the information it needs to make a decision.

  • If the claimant is notified by telephone, the determination will also be confirmed in writing not later than 3 days after the telephone notification.If an Urgent Care Claim is an Incomplete Claim, the claimant will be notified as soon as possible, but not later than 24 hours after receipt of the Incomplete Claim, of the specific information necessary to complete the claim.

  • The commission finds the rates reasonable and adopts the rates with correct COLA calculations as follows: 2018 from $379 to $380.00 2019 from $388 to $390.00 2020 from $396 to $395.00 Incomplete Claim Preparation: PART IV; and Appendix NCLC did not fully complete Part IV and Appendix of the claim.

Related to Incomplete Claim

  • Incomplete vehicle means any vehicle which must undergo at least one further stage of completion in order to meet the relevant technical requirements of this Directive;

  • Cure Claim means a Claim (unless waived or modified by the applicable counterparty) based upon a Debtor’s defaults under an Executory Contract or an Unexpired Lease assumed by such Debtor under section 365 of the Bankruptcy Code, other than a default that is not required to be cured pursuant to section 365(b)(2) of the Bankruptcy Code.

  • Rejection Claim means a Claim arising from the rejection of an Executory Contract or Unexpired Lease pursuant to section 365 of the Bankruptcy Code.

  • De Minimis Claim has the meaning set forth in Section 7.4(a).

  • Asbestos claim means any claim, wherever or whenever made, for damages, losses, indemnification, contribution, or other relief arising out of, based on, or in any way related to asbestos, including:

  • Material Document Defect As defined in Section 2.03(a) of this Agreement.

  • Tax Claim has the meaning set forth in Section 6.05.

  • Disputed Claim means any Claim that is not Allowed.

  • Intercompany Claim means any Claim held by a Debtor against another Debtor.

  • AWR Claim means any complaint or claim to a tribunal or court made by or on behalf of the Agency Worker against the Hirer and/or the Employment Business for any breach of the AWR;

  • Contested Claim means any Tax, Indebtedness or other claim or liability (i) the validity or amount of which is being diligently contested in good faith, (ii) for which adequate reserve, or other appropriate provision, if any, as required in conformity with GAAP shall have been made, and (iii) with respect to which any right to execute upon or sell any assets of the Company or of any of its Subsidiaries has not matured or has been and continues to be effectively enjoined, superseded or stayed.

  • IPR Claim means any claim of infringement or alleged infringement (including the defence of such infringement or alleged infringement) of any IPR, used to provide the Services or as otherwise provided and/or licensed by the Supplier (or to which the Supplier has provided access) to the Authority in the fulfilment of its obligations under this Framework Agreement;

  • Unresolved Claim means a Claim, which at the relevant time, in whole or in part: (a) has not been Finally Determined to be a Proven Claim in accordance with the Amended Claims Procedure Order and this Plan; (b) is validly disputed in accordance with the Amended Claims Procedure Order; and/or (c) remains subject to review and for which a Notice of Allowance or Notice of Revision or Disallowance (each as defined in the Amended Claims Procedure Order) has not been issued to the Creditor in accordance with the Amended Claims Procedure Order as at the date of this Plan, in each of the foregoing clauses, including both as to proof and/or quantum;

  • Deficiency Claim means any portion of a Claim (a) to the extent the value of the holder’s interest in Assets securing such Claim is less than the amount of such Claim or (b) to the extent the amount of a Claim is subject to setoff is less than the amount of the Claim, each as determined by § 506(a) of the Bankruptcy Code.

  • Erroneous Payment Return Deficiency has the meaning assigned thereto in Section 10.12(d).

  • Warranty Claim means a claim for breach of any of the Warranties.

  • Urgent Care Claim means a claim for medical care or treatment where making a non-urgent care decision: (a) could seriously jeopardize the life or health of the claimant or the ability of the claimant to regain maximum function, as determined by an individual acting on behalf of the plan applying the judgment of a prudent layperson who possesses an average knowledge of health and medicine; or (b) in the opinion of a physician with knowledge of the claimant’s medical condition, would subject the claimant to severe pain that cannot be adequately managed without the care.

  • Test Incomplete has the meaning stated in Section 3.4(a).

  • Document Defect As defined in Section 2.03(a).

  • Unsecured Claim means a Claim that is not an Administrative Claim, a Priority Tax Claim, a Priority Claim, or a Secured Claim.

  • Third Person Claim has the meaning specified in Section 11.4(a).

  • Indemnity Claim has the meaning set forth in Section 8.3.

  • Liability Claim has the meaning set forth in Section 7.2(a).

  • Deficiency Claim Date means, with respect to any Distribution Date, the fourth Business Day immediately preceding such Distribution Date.

  • D&O Claim means any right or claim of any Person against one or more of the Directors and/or Officers howsoever arising on or before the D&O Bar Date, for which the Directors and/or Officers, or any of them, are by statute liable to pay in their capacity as Directors and/or Officers or which are secured by way of any one of the Directors’ Charges;

  • Administrative Claim means a Claim for costs and expenses of administration of the Chapter 11 Cases pursuant to sections 503(b), 507(a)(2), 507(b), or 1114(e)(2) of the Bankruptcy Code, including: (a) the actual and necessary costs and expenses incurred on or after the Petition Date until and including the Effective Date of preserving the Estates and operating the Debtors’ businesses; (b) Allowed Professional Fee Claims; and (c) all payments afforded administrative expense treatment under the Backstop Agreement.