Common use of Post Service Claims Clause in Contracts

Post Service Claims. In the case of a Post-Service Claim, CareFirst shall notify the Member of the CareFirst’s Adverse Benefit Determination within a reasonable period of time, but not later than 30 days after receipt of the claim. This period may be extended one time by CareFirst for up to 15 days, provided that CareFirst both determines that such an extension is necessary due to matters beyond the control of CareFirst and notifies the Member, prior to the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which CareFirst expects to render a decision. If such an extension is necessary due to a failure of the Member to submit the information necessary to decide the claim, the notice of extension shall specifically describe the required information, and the Member shall be afforded at least 45 days from receipt of the notice within which to provide the specified information.

Post Service Claims. In the case of a Post-Service Claim, CareFirst shall notify the Member of the CareFirst’s Adverse Benefit Determination within a reasonable period of time, but not later than 30 thirty (30) days after receipt of the claim. This period may be extended one time by CareFirst for up to 15 fifteen (15) days, provided that CareFirst both determines that such an extension is necessary due to matters beyond the control of CareFirst and notifies the Member, prior to the expiration of the initial thirty (30-) day period, of the circumstances requiring the extension of time and the date by which CareFirst expects to render a decision. If such an extension is necessary due to a failure of the Member to submit the information necessary to decide the claim, the notice of extension shall specifically describe the required information, and the Member shall be afforded at least 45 forty-five (45) days from receipt of the notice within which to provide the specified information.