Complete Claim means a claim form that contains essential data elements listed in North Carolina’s prompt payment statue to reasonably enable the Payor or designee, as appropriate, to process the request for payment; a Complete Claim may be paper or a mutually acceptable electronic format.
Complete Claim means a Benefits claim for which MHHSI has been provided with all information necessary to process the claim.
Complete Claim means a claim that contains all of the necessary information and supporting documentation, if applicable, to render a decision on the claim and is submitted within the prescribed timeframe under the Plan’s reasonable claims procedures.
Examples of Complete Claim in a sentence
In accordance with the terms of the Plan Document and this Agreement, MHHSI will process and pay each Complete Claim in accordance with Exhibit A.
More Definitions of Complete Claim
Complete Claim means a claim for benefits for a Covered Person that has been submitted by a licensed Health Care Provider or the Covered Person, void of any omissions of pertinent information, coordination of benefits or liability issues, in a form satisfactory to TPA and with sufficient documentation to substantiate the claim for benefits under the Plan that is necessary or required according to industry standards or requirements in order for the TPA to make a determination of benefits under the Plan.
Complete Claim means, unless applicable law otherwise requires, an accurate Claim submitted pursuant to this Agreement, for which all information necessary to process such Claim and make a benefit determination is included.
Complete Claim means a claim or portion thereof, if separable, including attachments and supplemental information or documentation, which provides “reasonably relevant information” as defined by Section 1300.71(a)(10) of Title 28 of the California Code of Regulations “information necessary to determine payor liability” as further defined in section (a)(11).
Complete Claim means a claim or portion thereof, if separable, including attachments and supplemental information or documentation, which provides: "reasonably relevant information" as defined by section (a)(10), "information necessary to determine payer liability" as defined in section (a)(11) and:
Complete Claim means necessary information required by the TPA to adjudicate the claim.
Complete Claim means a claim for charges that is not in dispute, is not missing any information necessary to process said claim, is not under appeal as to the benefit entitled for such claim, or does not involve coordination of benefits, third party liability or subrogation, and is represented by a properly completed billing form (UB-04 and CMS 1500 or an acceptable electronic equivalent as determined by Contractor).
Complete Claim means a Claim for covered services submitted by a Health Care Provider or a Policyholder which contains all information necessary to Process and Pay such Claim as specified in a Health Plan’s published Complete Claim Standard.