Post-Service Claims definition

Post-Service Claims means claims for benefits that are not conditioned on the Eligible Person seeking advance approval, certification, or authorization to receive the full amount of any covered benefit. In other words, Post- Service Claims arise when the Eligible Person receives the dental service or treatment before the claim is filed for Benefits.
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Examples of Post-Service Claims in a sentence

  • Post-Service Medical Necessity ReviewA Post-Service Medical Necessity Review or Post-Service Claims Request, also known as a retrospective medical necessity review, is the process of determining coverage after treatment has been provided and is based on Medical Necessity guidelines.

  • Post-Service Claims must be submitted to AvMed within 90 days from the date of service or within one year unless the Member was legally incapacitated; otherwise the Claim will be considered to have been waived.

  • In most cases, initial claims decisions on Post-Service Claims will be made within thirty (30) days of the Plan’s receipt of the claim.

  • These claims are subject to the rules on Post-Service Claims described below.

  • Post-Service Claims must be filed with Us. If the Physician declines to file Your Post-Service Claim for You, You can obtain a Post-Service Claim form from Our Customer Service Department.

  • Post-Service Claims should be filed directly with Us. If a Hospital or other facility will not file Your Post-Service Claim for You, You can obtain a Post-Service Claim form from Our Customer Service Department.

  • These representatives can also help you file a claim for Emergency Services and Urgent Care Services outside of our Service Area (see Post-Service Claims) or to initiate an Appeal for any unresolved problem.We want you to be satisfied with your health care.

  • As used with respect to Pre-Service, Concurrent Care or Post-Service Claims and Appeals related thereto, the term “Member” “you” or “your” shall include an Authorized Representative, as defined above.If you miss a deadline for filing a claim or Appeal, we may decline to review it.

  • Except as indicated in the preceding sentence, Post-Service Claims will be barred if proof of loss (filing initial claim) is not furnished within one (1) year from the date incurred.

  • The 2nd Level Formal Appeal is voluntary for all Pre-Service and Post-Service Claims for Benefits.

Related to Post-Service Claims

  • Post-Service Claim means a claim for payment for medical care that already has been provided.

  • Pre-Service Claim means a claim for a medical care benefit with respect to which the plan conditions receipt of the benefit, in whole or in part, on approval of the benefit in advance of receipt of care.

  • Pharmacist services means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy.

  • Claims Administration means the processing and payment of claims received from Settlement Class Members by the Claims Administrator.

  • Asset Management Plan means a strategic document that states how a group of assets are to be managed over a period of time. The plan describes the characteristics and condition of infrastructure assets, the levels of service expected from them, planned actions to ensure the assets are providing the expected level of service, and financing strategies to implement the planned actions. The plan may use any appropriate format, as long as it includes the information and analysis required to be in a plan as described in Ontario’s Building Together: Guide for Asset Management Plans.

  • Appraisal management services means one or more of the following:

  • Inpatient services means services provided to you as an admitted inpatient in a recognised private or public hospital for treatment that is in an included clinical category, has a Medicare item number allocated and a Medicare benefit is payable.

  • Pharmacy benefits management means the administration or management of prescription drug

  • Procurement Management means the Director of Lee County’s Procurement Management Department or designee.

  • LOCKHEED MARTIN Procurement Representative means a person authorized by LOCKHEED MARTIN's cognizant procurement organization to administer and/or execute this Contract.

  • Irregularity in testing administration means the failure to administer an examination in the manner intended by the person or entity that created the examination.

  • Rehabilitative services means specialized services provided by a therapist or a therapist’s assistant to a resident to attain optimal functioning, including, but not limited to, physical therapy, occupational therapy, speech and language therapy, and audiology.

  • SITC means the Standard International Trade Classification, Revision 3 (SITC, Rev. 3), published by the United Nations in Statistical Papers, Series M, No. 34/Rev. 3 (1986);

  • Intermittent stream means all watercourses identified as intermittent streams on United States Geological Survey quadrangle maps.

  • Group Grievance is defined as a single grievance, signed by a Xxxxxxx or a Union Representative on behalf of a group of employee who have the same complaint. Such grievances must be dealt with at successive stages of the Grievance Procedure commencing with Step 1. The grievors shall be listed on the grievance form.

  • Homemaker services means the professionally directed or supervised simple household maintenance or management services provided by trained homemakers or individuals to families in their own homes.

  • Source reduction means any practice that reduces the amount of any hazardous substance, pollutant, or contaminant entering any waste stream or otherwise released into the environment prior to recycling, energy recovery, treatment, or disposal.

  • Asset Management is a principle/practice that includes planning processes, approaches, plans, or related documents that support an integrated lifecycle approach to the effective stewardship of infrastructure assets to maximize benefits and effectively manage risk.

  • Intermittent Resource means a Generation Capacity Resource with output that can vary as a function of its energy source, such as wind, solar, run of river hydroelectric power and other renewable resources.

  • water services means water supply services and sanitation services;

  • Drug therapy management means the review of a drug therapy regimen of a patient by one or more pharmacists for the purpose of evaluating and rendering advice to one or more practitioners regarding adjustment of the regimen.

  • Rehabilitation counseling services means services provided by qualified personnel in individual or group sessions that focus specifically on career development, employment preparation, achieving independence, and integration in the workplace and community of a student with a disability. The term also includes vocational rehabilitation services provided to a student with disabilities by vocational rehabilitation programs funded under the Rehabilitation Act of 1973, as amended.

  • Inpatient hospital services means any health care service provided to a patient who has been admitted to a hospital and is required to remain in that hospital overnight, but does not include any secure forensic mental health services;

  • Rechargeable Electrical Energy Storage System (REESS) means the rechargeable energy storage system that provides electric energy for electrical propulsion.

  • Pharmacy intern means a person who has all of the

  • Habilitative services means those services provided by