Concurrent Care Claim Reduction or Termination Sample Clauses

Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. With enough advance notice to allow the Member to file an Appeal. If the Member files an Appeal, Covered Benefits under the Certificate will continue for the previously approved course of treatment until a final Appeal decision is rendered. During this continuation period, the Member is responsible for any Copayments that apply to the services; supplies; and treatment; that are rendered in connection with the claim that is under Appeal. If HMO's initial claim decision is upheld in the final Appeal decision, the Member will be responsible for all charges incurred for services; supplies; and treatment; received during this continuation period. Post-Service Claim. A claim for a benefit that is not a pre-service claim. Within 30 calendar days. HMO may determine that due to matters beyond its control an extension of this 30-calendar day claim decision period is required. Such an extension, of not longer than 15 additional calendar days, will be allowed if HMO notifies the Member within the first 30 calendar day period. If this extension is needed because HMO needs more information to make a claim decision, the notice of the extension shall specifically describe the required information. The Member will have 45 calendar days, from the date of the notice, to provide HMO with the required information.
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Concurrent Care Claim Reduction or Termination. A decision to reduce or terminate a course of treatment that was previously approved.
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Concurrent Care Claim Reduction or Termination. Aetna will notify the covered person of a claim decision to reduce or terminate a previously approved course of treatment with enough time for the covered person to file an appeal. If the covered person files an appeal, coverage under the plan will continue for the previously approved course of treatment until a final appeal decision is rendered. During this continuation period, the covered person is responsible for any copayments; coinsurance; and deductibles; that apply to the services; supplies; and treatment; that are rendered in connection with the claim that is under appeal. If Aetna's initial claim decision is upheld in the final appeal decision, the covered person will be responsible for all charges incurred for services; supplies; and treatment; received during this continuation period.
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Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. Post-Service Claim. A claim for a benefit that is not a pre- service claim. If an urgent care claim, as soon as possible but not later than 24 hours. Otherwise, within 15 calendar days With enough advance notice to allow the Member to Appeal. Within 30 calendar days
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Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. Post-Service Claim. A claim for a benefit that is not a pre- service claim. As soon as possible but not later than 24 hours Within 15 calendar days If an urgent care claim, as soon as possible but not later than 24 hours. Otherwise, within 15 calendar days With enough advance notice to allow the Member to Appeal. Within 14 business days for a claim that involves Utilization Review. Otherwise, within 30 calendar days COMPLAINTS AND APPEALS HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO. The procedure the Member needs to follow will depend on the type of issue or problem the Member has. • Appeal. An Appeal is a request to the HMO to reconsider an adverse benefit determination. The Appeal procedure for an adverse benefit determination has two levels. • Complaint. A Complaint is an expression of dissatisfaction about quality of care or the operation of the HMO.
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Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. Post-Service Claim. A claim for a benefit that is not a pre- service claim. As soon as possible but not later than 72 hours. Within 2 business days of a request for preauthorization for a treatment, procedure, drug or device (unless additional information is required). Within 24 hours of a request for preadmission. If an urgent care claim, as soon as possible but not later than 24 hours. Within 24 hours of preauthorization of treatment during a hospitalization. Within 24 hours of receipt of a request for review of a Member’s continued Hospital stay and prior to the time when a previous authorization for Hospital care will expire Within 20 business days. COMPLAINTS AND APPEALS HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO. The procedure the Member needs to follow will depend on the type of issue or problem the Member has. If the state of Kentucky requirements are more beneficial to the Member, the state requirements will govern. • Appeal. An Appeal is a request to the HMO to reconsider an adverse benefit determination. • Complaint. A Complaint is an expression of dissatisfaction about quality of care or the operation of the HMO.
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Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. With enough advance notice to allow the Member to Appeal. Post-Service Claim. A claim for a benefit that is not a pre-service claim. Within 30 calendar days. COMPLAINTS AND APPEALS HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO. The procedure the Member needs to follow will depend on the type of issue or problem the Member has. • Appeal. An Appeal is a request to the HMO to reconsider an adverse benefit determination. The Appeal procedure for an adverse benefit determination has two levels. • Complaint. A Complaint is an expression of dissatisfaction about quality of care or the operation of the HMO. The Complaint procedure may, if the Member chooses, follow the same path as an Adverse Benefit Determination.
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Concurrent Care Claim Reduction or Termination. A decision to reduce or terminate a previously approved course of treatment. Pre-Service Claim: Any claim for medical care or treatment that requires approval before the medical care or treatment is received. Post-Service Claim: Any claim that is not a “Pre-Service Claim.” Urgent Care Claim: Any claim for medical care or treatment in which a delay in treatment could:  jeopardize your life;  jeopardize your ability to regain maximum function;  cause you to suffer severe pain that cannot be adequately managed without the requested medical care or treatment; or  In the case of a pregnant woman, cause serious jeopardy to the health of the fetus. Claim Determinations Urgent Care Claims Aetna will make notification of an urgent care claim determination as soon as possible but not more than 72 hours after the claim is made. If more information is needed to make an urgent claim determination, Aetna will notify the claimant within 24 hours of receipt of the claim. The claimant has 48 hours after receiving such notice to provide Aetna with the additional information. Aetna will notify the claimant within 48 hours of the earlier of the receipt of the additional information or the end of the 48 hour period given the physician to provide Aetna with the information. If the claimant fails to follow plan procedures for filing a claim, Aetna will notify the claimant within 24 hours following the failure to comply. Pre-Service Claims Aetna will make notification of a claim determination as soon as possible but not later than 15 calendar days after the pre-service claim is made. Aetna may determine that due to matters beyond its control an extension of this 15 calendar days claim determination period is required. Such an extension, of not longer than 15 additional calendar days, will be allowed if Aetna notifies you within the first 15 calendar days period. If this extension is needed because Aetna needs additional information to make a claim determination, the notice of the extension shall specifically describe the required information. You will have 45 calendar days, from the date of the notice, to provide Aetna with the required information. Post-Service Claims Aetna will make notification of a claim determination as soon as possible but not later than 30 calendar days after the post-service claim is made. Aetna may determine that due to matters beyond its control an extension of this 30 calendar day claim determination period is required. Such an extension, of not lo...
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Concurrent Care Claim Reduction or Termination. Aetna will make notification of a claim determination to reduce or terminate a previously approved course of treatment with enough time for you to file an appeal.
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Related to Concurrent Care Claim Reduction or Termination

  • Modification or Termination The Loan Documents may only be modified or terminated by a written instrument or instruments intended for that purpose and executed by the party against which enforcement of the modification or termination is asserted. Any alleged modification or termination which is not so documented shall not be effective as to any party.

  • Contract Renegotiation, Suspension, or Termination Due to Change in Funding If the funds DSHS relied upon to establish this Contract or Program Agreement are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, after the effective date of this contract but prior to the normal completion of this Contract or Program Agreement:

  • Dissolution or Termination Any particular Series shall be dissolved upon the occurrence of the applicable dissolution events set forth in Article VIII, Section 1 hereof. Upon dissolution of a particular Series, the Trustees shall wind up the affairs of such Series in accordance with Article VIII Section 1 hereof and thereafter, rescind the establishment and designation thereof. The Board of Trustees shall terminate any particular Class and rescind the establishment and designation thereof: (i) upon approval by a majority of votes cast at a meeting of the Shareholders of such Class, provided a quorum of Shareholders of such Class are present, or by action of the Shareholders of such Class by written consent without a meeting pursuant to Article V, Section 3; or (ii) at the discretion of the Board of Trustees either (A) at any time there are no Shares outstanding of such Class, or (B) upon prior written notice to the Shareholders of such Class; provided, however, that upon the rescission of the establishment and designation of any particular Series, every Class of such Series shall thereby be terminated and its establishment and designation rescinded. Each resolution of the Board of Trustees pursuant to this Section 6(i) shall be incorporated herein by reference upon adoption.

  • Expiration or Termination A. Owner shall have the right, upon thirty (30) days prior written notice to Operator, to terminate this Agreement in its entirety, upon or after the happening of one or more of the following events, if said event or events shall then be continuing:

  • Cancellation or Termination The Provider is the responsible party for honoring cancellation requests. Such requests must be received in writing. You may cancel this Service Agreement at any time (send your written request to us at xxxxxxxxxxxxx@0-00.xxx) and is non-cancelable by us, except for:

  • Amendment, Suspension or Termination of the Plan By accepting this Award, Participant expressly warrants that he or she has received an Award of Restricted Stock Units under the Plan, and has received, read and understood a description of the Plan. Participant understands that the Plan is discretionary in nature and may be amended, suspended or terminated by the Company at any time.

  • Reduction or Termination of Commitments Unless previously terminated, the Commitments shall terminate on the Revolving Commitment Termination Date. The Borrower shall have the right, upon not less than two Business Days’ written notice to the Administrative Agent, to terminate the Commitments or, from time to time, reduce the amount of the Commitments; provided, however, that the Borrower shall not terminate or reduce any Commitment if, after giving effect to any concurrent repayment of the Loans in accordance with Section 2.07 and Section 2.08, the total Credit Exposure of the Lenders would exceed the sum of total Commitments. Any reduction shall be accompanied by prepayment of the Loans to the extent, if any, that the total Credit Exposure of the Lenders then outstanding exceeds the sum of the total Commitments as then reduced. Any termination of the Commitments shall be accompanied by prepayment in full of the Loans then outstanding and the payment of any unpaid fees then accrued hereunder. Upon receipt of such notice, the Administrative Agent shall promptly notify each Lender thereof. Any partial reduction shall be in an amount of $5,000,000 or a whole multiple thereof and shall reduce permanently the total amount of the Commitments, together with a corresponding reduction in the aggregate amount of each Lender’s applicable Commitment. The Commitments, once terminated or reduced, may not be reinstated. Each reduction of the Commitments shall be made ratably among the Lenders in accordance with their Commitments (except for in connection with the termination of this Agreement as to any Lender pursuant to Section 10.15).

  • Resignation or Termination of Agent The Agent may resign at any time on ten (10) days’ prior notice, so long as a successor Agent, reasonably satisfactory to the Note Holders (it being agreed that a Servicer, the Trustee or a Certificate Administrator in a Securitization is satisfactory to the Note Holders), has agreed to be bound by this Agreement and perform the duties of the Agent hereunder. UBS AG, New York Branch, as Initial Agent, may transfer its rights and obligations to a Servicer, the Trustee or the Certificate Administrator, as successor Agent, at any time without the consent of any Note Holder. Notwithstanding the foregoing, Note Holders hereby agree that, simultaneously with the closing of the Lead Securitization, the Master Servicer shall be deemed to have been automatically appointed as the successor Agent under this Agreement in place of UBS AG, New York Branch without any further notice or other action. The termination or resignation of such Master Servicer, as Master Servicer under the Lead Securitization Servicing Agreement, shall be deemed a termination or resignation of such Master Servicer as Agent under this Agreement, and any successor master servicer shall be deemed to have been automatically appointed as the successor Agent under this Agreement in place thereof without any further notice or other action.

  • Notice of Voluntary Termination or Reduction The Borrower shall notify the Administrative Agent of any election to terminate or reduce the Commitments under paragraph (b) of this Section at least three Business Days prior to the effective date of such termination or reduction, specifying such election and the effective date thereof. Promptly following receipt of any notice, the Administrative Agent shall advise the applicable Lenders of the contents thereof. Each notice delivered by the Borrower pursuant to this Section shall be irrevocable; provided that a notice of termination of the Commitments of a Class delivered by the Borrower may state that such notice is conditioned upon the effectiveness of other credit facilities, in which case such notice may be revoked by the Borrower (by notice to the Administrative Agent on or prior to the specified effective date) if such condition is not satisfied.

  • Voluntary Termination or Reduction The Borrower may at any time terminate, or from time to time reduce, the Commitments; provided that (i) each reduction of the Commitments pursuant to this Section 2.06(b) shall be in an amount that is $5,000,000 or a larger multiple of $1,000,000 in excess thereof and (ii) the Borrower shall not terminate or reduce the Commitments if, after giving effect to any concurrent prepayment of the Loans in accordance with Section 2.08, the total Revolving Credit Exposures would exceed the total Commitments.

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