Noblesville Schools Medical Plan 82 Section 6: Questions, Complaints and Appeals Urgent Care Request for Benefits* Type of Request for Benefits or Appeal Timing If your request for Benefits is incomplete, the Claims Administrator must notify you within: 24 hours You must then provide completed request for Benefits to the Claims Administrator within: 48 hours after receiving notice of additional information required The Claims Administrator must notify you of the benefit determination within: 72 hours If the Claims Administrator denies your request for Benefits, you must appeal an adverse benefit determination no later than: 180 days after receiving the adverse benefit determination The Claims Administrator must notify you of the appeal decision within: 72 hours after receiving the appeal *You do not need to submit urgent care appeals in writing. You should call the Claims Administrator as soon as possible to appeal an urgent care request for Benefits. Pre-Service Request for Benefits* Type of Request for Benefits or Appeal Timing If your request for Benefits is filed improperly, the Claims Administrator must notify you within: 5 days If your request for Benefits is incomplete, the Claims Administrator must notify you within: 15 days You must then provide completed request for Benefits information to the Claims Administrator within: 45 days The Claims Administrator must notify you of the benefit determination: • if the initial request for Benefits is complete, within: 15 days • after receiving the completed request for Benefits (if the initial request for Benefits is incomplete), within: 15 days You must appeal an adverse benefit determination no later than: 180 days after receiving the adverse benefit determination The Claims Administrator must notify you of the first level appeal decision within: 15 days after receiving the first level appeal You must appeal the first level appeal (file a second level appeal) within: 60 days after receiving the first level appeal decision