Concurrent Care Claim definition

Concurrent Care Claim means any request by a Claimant that relates to an Urgent Care Claim to extend a course of treatment beyond the initial period of time or number of treatments previously approved.

Concurrent Care Claim. A request that Health Plan continue to approve an ongoing course of covered treatment to be provided over a period of time or number of treatments, when either the course of treatment prescribed will:

Concurrent Care Claim means any decision in which We, after having previously approved an ongoing course of Care provided over a period of time or a specific number of treatments, either:

Examples of Concurrent Care Claim in a sentence

• In the event a Concurrent Care Claim results in an Adverse Benefit Determination, AvMed will notify the Claimant at a time sufficiently in advance of the reduction or termination to allow the Claimant to appeal and obtain a determination on review before the benefit is reduced or terminated.

• In the event a Concurrent Care Claim results in an Adverse Benefit Determination AvMed will notify the Claimant at a time sufficiently in advance of the reduction or termination to allow the Claimant to appeal and obtain a determination on review before the benefit is reduced or terminated.

• Pre-Service Claims (May Include Concurrent Care Claim Reduction or Termination) Aetna shall issue a decision within 30 calendar days of receipt of the request for an appeal.

• Urgent Care Claims (May Include Concurrent Care Claim Reduction or Termination) Aetna shall issue a decision within 72 hours of receipt of the request for an appeal.

• In the event a Concurrent Care Claim results in an Adverse Benefit Determination AvMed shall notify the Claimant at a time sufficiently in advance of the reduction or termination to allow the Claimant to appeal and obtain a determination on review, before the benefit is reduced or terminated.

More Definitions of Concurrent Care Claim

Concurrent Care Claim means a Health Care Claim to extend an ongoing course of treatment beyond the period of time or number of treatments authorized by the Administrator.

Concurrent Care Claim means: (1) a claim to continue a previously approved course of treatment under a group health plan for a specific time period or number of treatments that has been reduced or terminated before the end of the approved course of treatment or (2) to continue a course of treatment beyond the specific time period or number of treatments previously approved under a group health plan. A Concurrent Care Claim may be for urgent or non- urgent healthcare. Notwithstanding the foregoing, a group health benefit for an ongoing course of treatment that has been reduced or terminated as a result of Plan termination or amendment will not be considered a claim.

Concurrent Care Claim means a Claim for an ongoing course of treatment to be provided over a period of time or number of treatments. Any reduction or termination by the Health Benefit Program of the course of treatment (other than by plan amendment or termination) before the end of the period of time or number of treatments originally approved is considered an Adverse Benefit Determination.

Concurrent Care Claim means an ongoing course of treatment to be provided over a period of time or number of treatments that AvMed previously approved. A Concurrent Care Claim is any requested by a Claimant that relates to an Urgent Care Claim to extend the course of treatment beyond the initial period of time or number oftreatments. Any reduction or termination by AvMed of Concurrent Care (other than by an amendment to this Plan or termination), before the end of an approved period of time or number of treatments, shall constitute an Adverse Benefit Determination.

Concurrent Care Claim means a claim for an ongoing course of treatment over a period of time or number of treatments that is being reconsidered after the original pre-authorization and before the end of the course of treatment;

Concurrent Care Claim means a claim for which the Plan Administrator approves ongoing treatment to be provided over a period of time.

Concurrent Care Claim means a claim with prior authorization that is reconsidered after a course of treatment has been initially approved. There are two types of Concurrent Care Claims: (i) where the reconsideration results in a reduction or termination of coverage for a previously approved course of treatment, and (ii) where an extension is requested by the Claimant for coverage beyond the initially approved course of treatment.