Claims Processing Sample Clauses
The Claims Processing clause outlines the procedures and requirements for submitting, reviewing, and resolving claims under the agreement. Typically, it specifies the documentation needed, timelines for notification and response, and the steps each party must follow to ensure a claim is properly handled. This clause ensures that any disputes or requests for compensation are managed in an orderly and timely manner, reducing misunderstandings and facilitating efficient resolution of issues.
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Claims Processing. 4.16 Within reasonable time of receiving a Claim Form and any accompanying documentation, the Settlement Administrator will review the documentation and/or AHM’s records and either confirm or deny the Settlement Class Member’s eligibility for the HondaLink Benefit, Sirius XM Benefit, and/or out-of-pocket expense reimbursement (as applicable).
4.17 If the determination is to deny a Claim, the Settlement Administrator will send, within sixty (60) days after determination of denial, notice of the denial to the Settlement Class Member. Such notice will set forth the reason(s) for the denial and provide notice of the claimant’s right to contest the denial and request reconsideration and/or to attempt to cure any defect within thirty (30) days. On a quarterly basis after the Effective Date until all Claims have been processed, the Settlement Administrator will provide to Class Counsel a list of all Claims that have been denied, along with the Claim Forms and supporting documentation and other relevant information relating to the denial with appropriate PII redactions.
4.18 Claims that do not meet the requirements set forth in the Settlement Agreement shall be denied. Grounds for rejection include, but are not limited to, failure to provide Proof of Expenses or any other required information, untimely submission of the Claim Form, or submission of ineligible repair expenses.
4.19 A Settlement Class Member whose Claim has been denied may attempt to cure the deficiency or contest the decision denying the Claim by mailing to the Settlement Administrator at the mailing address for the administration of this Settlement, written notice containing information to attempt to cure any claim deficiencies or a statement of reasons the Settlement Class Member contests the denial, along with any additional supporting documentation (the “Contest Notice”). Any Contest Notice must be postmarked within thirty (30) days after the date of mailing by the Settlement Administrator of the notice of the denial of the Claim. The Contest Notice procedures shall be posted on the Settlement Website and shall also be provided in writing to any Settlement Class Member whose Claim is denied.
4.20 Within sixty (60) days after the Settlement Class Member mails the Contest Notice, the Settlement Administrator shall consider the claimant’s request for reconsideration and any materials submitted by the Settlement Class Member in support thereof, and mail to the Settlement Class Member a final determ...
Claims Processing. BCBSM will process Provider's Clean Claims submitted in accordance with this Agreement in a timely fashion.
Claims Processing. The carrier may conduct audits of claims being processed such as an analysis of patient histories and screening for duplicate payments in addition to the normal eligibility, benefit and charge verifications.
Claims Processing. The customer is informed that, in the event of wish- ing to file a claim, they can contact Kampaoh Agencia de Viajes S.L. at the following email address: ▇▇▇▇▇@▇▇▇▇▇▇▇.▇▇▇ or by postal mail to ▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇, ▇▇ – ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇ ▇▇▇, ▇▇▇▇▇▇ ▇▇ Guadaíra (Sevilla), Postal Code 41500. Likewise, and in compliance with the provisions of Article 40 of Law 7/2017 on alternative dispute resolution for consumer disputes, it is informed that Kampaoh Agencia de Viajes S.L. is not affiliated with any organization and/or entity for the alternative res- olution of such disputes. Notwithstanding the above, if you disagree with the solution adopted by us re- ▇▇▇▇▇▇▇ your claim, you may contact the Consumer Arbitration Board of your respective Autonomous Com- munity and/or Municipality, as well as the Directorate- General for Tourism. In any case, it is informed that Kampaoh Agencia de Viajes S.L. will not participate in the arbitration procedure before the aforementioned entities. It is also informed that the limitation period for filing claims under Royal Legislative Decree 1/2007, of November 16, approving the consolidated text of the General Law for the Defense of Consumers and Users and other complementary laws, is two years.
Claims Processing. Health Plan shall pay or deny Clean Claims within the time period set forth in Attachment C. Health Plan uses claims editing software programs to assist it in determining proper coding for provider claim reimbursement. Such software programs use industry standard coding criteria and incorporate guidelines established by CMS such as the National Correct Coding Initiative and the National Physician Fee Schedule Database, the AMA and Specialty Society correct coding guidelines, and state specific regulations. These software programs may result in claim edits for specific procedure code combinations.
Claims Processing. HEBP will receive claims, enter claims data into the claims processing system, determine whether benefits are payable in accordance with the Plan Administrator’s specifications, provide utilization review, apply allowable amount determinations, and administer coordination of benefits with other plans, when appropriate. HEBP will use its best efforts to correctly process claims and pay benefits in accordance with information provided by the Plan Administrator.
Claims Processing. In accordance with Section 5, process all claims arising under policies and contracts. Maintain claim documents, files and related information. Maintain and update beneficiary designations and life assignments. Control and maintain all draft and check stock, claim forms and other forms and documents incidental to claims processing. Maintain claims procedural manuals and other instructions. Monitor claims for possible fraud.
Claims Processing. PacifiCare shall establish and maintain standards, policies and procedures for the timely and accurate processing and payment of claims for Covered Services provided to Members (“Claims Processing Guidelines”). The Claims Processing Guidelines shall be maintained in accordance with the requirements of State and Federal Law and the Managed Care Plans.
Claims Processing. All claims will be submitted by the DVA/VHA medical facility and shall be processed as participating claims even if not so indicated on the claim form. Beneficiary submitted claims for care received at the DVA/VHA medical facility shall be denied using the EOB message: “Claims must be filed by the DVA/VHA Medical Facility.”
Claims Processing. The Company shall bear all necessary administrative expenses and agrees that in the administration of the insurance plan, all claims shall be processed as expediently as possible. All matters concerning benefits provided under the insurance plan shall be governed by the terms and conditions of the insurance policy or policies purchased by the Company.