Pre-Service Claim definition

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.

Pre-Service Claim means any Claim for Benefits under a Health Benefit Plan with respect to which the terms of the Plan condition receipt of the benefit, in whole or in part, on approval of the benefit in advance of obtaining medical care.

Pre-Service Claim means any Claim for Benefits under a Group Health Plan with respect to which the terms of the Plan condition receipt of the benefit, in whole or in part, on approval of the benefit in advance of obtaining medical care.

Examples of Pre-Service Claim in a sentence

• In the case of a failure by a Member or authorized representative to follow CareFirst BlueChoice procedures for filing a Pre-Service Claim, the Member or authorized representative shall be notified of the failure and the proper procedures to be followed in filing a claim for benefits.

• Pre-Service Claim means any claim for a benefit when the receipt of the benefit, in whole or in part, is conditioned on the prior approval of the service in advance by CareFirst BlueChoice.

• Post-Service Claim: any claim for a Benefit that is not a Pre-Service Claim.

• A Pre-Service Claim is any claim for a medical benefit which the Plan terms condition the Covered Person’s receipt of the benefit, in whole or in part, on approval of the benefit before obtaining treatment.

• AvMed will notify the Claimant of the benefit determination with respect to a Pre-Service Claim no later than 15 days after receipt of the Claim.

More Definitions of Pre-Service Claim

Pre-Service Claim means any Claim for a benefit under this Plan where the Plan conditions receipt of the benefit, in whole or in part, on approval in advance of obtaining Medical Care. These are, for example, Claims subject to Preauthorization.

Pre-Service Claim means the request for a plan benefit(s) by a claimant prior to a

Pre-Service Claim means a claim for a benefit under a group health plan that, under the terms of the applicable plan, conditions the receipt of the benefit, in whole or in part, on pre-approval of the benefit in advance of obtaining medical care.

Pre-Service Claim means any claim in which receipt of the benefit is conditioned, in whole or in part, upon precertification or preauthorization by the Plan.

Pre-Service Claim means any claim for a medical benefit the health plan conditions receipt of such benefit, in whole or in part, on approval of the benefit prior to obtaining medical care.

Pre-Service Claim means any Claim for benefits under this Contract for which, in whole or in part, a Claimant must obtain authorization from AvMed in advance of such services being provided to or received by the Member.

Pre-Service Claim means any medical, dental, or vision benefit claim on account of which the terms of the Plan condition receipt of the benefit, in whole or in part, on approval of the benefit in advance of obtaining medical care.