Post-Service Claims definition

Post-Service Claims means claims for benefits that are not conditioned on the Eligible Person seeking advance approval, certification, or authorization to receive the full amount of any covered benefit. In other words, Post- Service Claims arise when the Eligible Person receives the dental service or treatment before the claim is filed for Benefits.
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Examples of Post-Service Claims in a sentence

  • Types of ClaimsFor purposes of this Contract, there are three types of claims: (1) Post-Service Claims; (2) Pre-Service Claims; and (3) Claims Involving Urgent Care.

  • In any event, no Post-Service Claim will be considered for payment if we do not receive it at the address indicated on your ID Card within one year of the date the Service was rendered unless you are legally incapacitated.For Post-Service Claims, we must receive an itemized statement containing the following information:1.

  • Post-Service ClaimsHow to File a Post-Service ClaimExperience shows that the most common type of claim we will receive from you or your treating Providers will likely be Post-Service Claims.In-Network Providers have agreed to file Post-Service Claims with us for Health Care Services they render to you.

  • Post-Service Claims: within 60 days of our receipt of the Grievance; or3.

  • In most cases, initial claims decisions on Post-Service Claims will be made within thirty (30) days of the Plan’s receipt of the claim.

  • Post-Service Claims must be submitted to AvMed within 90 days from the date of service or within one year unless the Member was legally incapacitated; otherwise the Claim will be considered to have been waived.

  • Post-Service Medical Necessity ReviewA Post-Service Medical Necessity Review or Post-Service Claims Request, also known as a retrospective medical necessity review, is the process of determining coverage after treatment has been provided and is based on Medical Necessity guidelines.

  • There are four (4) types of claims: Pre-Service Claims, Urgent Care Claims, Post-Service Claims and Concurrent Care claims.

  • Post-Service ClaimsHow to File a Post-Service ClaimExperience shows that the most common type of claim we will receive from you or your treating Providers will likely be Post-Service Claims.NetworkBlue Providers and Traditional Insurance Providers have agreed to file Post-Service Claims with us for Health Care Services they render to you.

  • As used with respect to Pre-Service, Concurrent Care or Post-Service Claims and Appeals related thereto, the term “Member” “you” or “your” shall include an Authorized Representative, as defined above.If you miss a deadline for filing a claim or Appeal, we may decline to review it.

Related to Post-Service Claims

  • Post-Service Claim means a claim for payment for medical care that already has been provided.

  • 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.

  • Pharmacist services means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy.

  • Supply Chain Management All aspects of supply chain management, from the initial sourcing phase through customer delivery (e.g., procurement, sourcing management, inventory management, catalog management, ordering/purchasing, invoice tracking, storefront/shopping cart, warehouse management, returns management, logistics/transportation).

  • Claims Administration means the processing of claims made under the Shared Policies, including, without limitation, the reporting of claims to the insurance carriers and the management of the defense of claims.

  • Asset Management Plan means a plan created by the department and approved by the state transportation commission or a plan created by a local road agency and approved by the local road agency's governing body that includes provisions for asset inventory, performance goals, risk of failure analysis, anticipated revenues and expenses, performance outcomes, and coordination with other infrastructure owners.

  • Appraisal management services means one or more of the following:

  • Pharmacy benefits management means the administration or management of prescription drug

  • Procurement Management means the Director of Lee County’s Procurement Management Department or designee.

  • LOCKHEED MARTIN Procurement Representative means a person authorized by LOCKHEED MARTIN's cognizant procurement organization to administer and/or execute this Contract.

  • Irregularity in testing administration means the failure to administer an examination in the manner intended by the person or entity that created the examination.

  • SITC means the Standard International Trade Classification, Revision 3 (SITC, Rev. 3), published by the United Nations in Statistical Papers, Series M, No. 34/Rev. 3 (1986);

  • Intermittent stream means a well-defined channel that contains water for only part of the year, typically during winter and spring when the aquatic bed is below the water table. The flow may be heavily supplemented by stormwater runoff. An intermittent stream often lacks the biological and hydrological characteristics commonly associated with the continuous conveyance of water.

  • Group Grievance is defined as a single grievance, signed by a Xxxxxxx or a Union Representative on behalf of a group of employee who have the same complaint. Such grievances must be dealt with at successive stages of the Grievance Procedure commencing with Step 1. The grievors shall be listed on the grievance form.

  • Homemaker services means the professionally directed or supervised simple household maintenance or management services provided by trained homemakers or individuals to families in their own homes.

  • Pest Management Plan and “PMP” means the Recipient’s plan dated March 9, 2010, which: (i) addresses the concerns relating to the Project risks associated with potential increases in the use of pesticides for agricultural production, intensification and diversification and controlling disease vector populations arising from irrigation schemes; (ii) sets forth mitigation and monitoring measures to be taken during Project implementation and operation to eliminate adverse environmental and social impacts, offset them, or reduce them to acceptable levels; (iii) recommends institutional measures to strengthen national capacities to implement the mitigation and monitoring measures; and (iv) as part of the implementation arrangements, identifies national agencies and other partners that could play a vital role in the success of the Project.

  • Source reduction means any practice that reduces the amount of any hazardous substance, pollutant, or contaminant entering any waste stream or otherwise released into the environment prior to recycling, energy recovery, treatment, or disposal.

  • Project Management Report means each report prepared in accordance with Section 4.02 of this Agreement;

  • Medicare cost report means CMS-2552-10, the cost report for electronic filing of

  • Asset management means a systematic process of operating and maintaining the state system of

  • Intermittent Resource means a Generation Capacity Resource with output that can vary as a function of its energy source, such as wind, solar, run of river hydroelectric power and other renewable resources. Internal Market Buyer:

  • water services means water supply services and sanitation services;

  • Drug therapy management means the review of a drug therapy regimen of a patient by one or more pharmacists for the purpose of evaluating and rendering advice to one or more practitioners regarding adjustment of the regimen.

  • Rehabilitation counseling services means services provided by qualified personnel in individual or group sessions that focus specifically on career development, employment preparation, achieving independence, and integration in the workplace and community of a student with a disability. The term also includes vocational rehabilitation services provided to a student with disabilities by vocational rehabilitation programs funded under the Rehabilitation Act of 1973, as amended.

  • Burswood Casino means that area in the Resort Complex identified in the Drawings as the area to constitute the casino and includes the area in which money counting, surveillance, storage and other activities relating to the conduct and playing of Games are carried on or, if and when the area to which the Burswood Casino Licence relates is fixed pursuant to section 21(4a) of the Control Act, the area so fixed as thereafter altered from time to time in accordance with that section;

  • Pharmacy intern means a person who has all of the