When does the time period for making an initial decision on a claim begin to run?
The time for making an initial claims decision begins to run when the claim is filed in accordance with a plan’s reasonable filing procedures, regardless of whether the plan has all of the information necessary to decide the claim at the time of the filing. For purposes of calculating the time period within which a claim must be decided, a plan cannot extend the time period by treating as filed only those claims with respect to which all the information necessary to make a decision has been submitted (often referred to as clean claims). See 2560.503-1(f)(4).
The time for making an initial claims decision begins to run when the claim is filed in accordance with a plan’s reasonable filing procedures, regardless of whether the plan has all of the information necessary to decide the claim at the time of the filing. For purposes of calculating the time period within which a claim must be decided, a plan cannot extend the time period by treating as filed only those claims with respect to which all the information necessary to make a decision has been submitted (often referred to as clean claims). See ยง 2560.503-1(f)(4).
Related Questions
- Do the new time period requirements run from the date that notice or submission of claims are made to the insurer or from the date that notice or submission of claims are received by the insurer?
- How do you justify 270 days to be the time period after which a user is deemed not to be likely to claim their credits?
- When does the time period for making an initial decision on a claim begin to run?
