Part 9 – Filing a Claim (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 86 Timeliness of Claim Payments Within 30 calendar days after Blue Cross Blue Shield HMO Blue receives a completed request for coverage or payment, Blue Cross Blue Shield HMO Blue will make a decision. When appropriate, Blue Cross Blue Shield HMO Blue will make a payment to the health care provider (or to you in certain situations) for your claim to the extent of your coverage in this health plan. Or, Blue Cross Blue Shield HMO Blue will send you and/or the health care provider a notice in writing of why your claim is not being paid in full or in part. Missing Information If the request for coverage or payment is not complete or if Blue Cross Blue Shield HMO Blue needs more information to make a final determination for your claim, Blue Cross Blue Shield HMO Blue will ask for the information or records it needs. Blue Cross Blue Shield HMO Blue will make this request within 30 calendar days of the date that Blue Cross Blue Shield HMO Blue received the request for coverage or payment. This additional information must be provided to Blue Cross Blue Shield HMO Blue within 45 calendar days of this request.  Missing Information Received Within 45 Days. If the additional information is provided to Blue Cross Blue Shield HMO Blue within 45 calendar days of Blue Cross Blue Shield HMO Blue’s request, Blue Cross Blue Shield HMO Blue will make a decision within the time remaining in the original 30-day claim determination period. Or, Blue Cross Blue Shield HMO Blue will make the decision within 15 calendar days of the date that the additional information is received by Blue Cross Blue Shield HMO Blue, whichever is later.  Missing Information Not Received Within 45 Days. If the additional information is not provided to Blue Cross Blue Shield HMO Blue within 45 calendar days of Blue Cross Blue Shield HMO Blue’s request, the claim for coverage or payment will be denied by Blue Cross Blue Shield HMO Blue. If the additional information is submitted to Blue Cross Blue Shield HMO Blue after these 45 days, then it may be viewed by Blue Cross Blue Shield HMO Blue as a new claim for coverage or payment. In this case, Blue Cross Blue Shield HMO Blue will make a decision within 30 days as described previously in this section.