22 determination within 48 hours after the earlier of: (i) receipt of the required information, or (ii) the expira tion of the period afforded to c laimant to provide the information. In the case of an Adverse Benefit Determination , c laimant will be provided a description of the expe dited claim review process for urgent care c laims. Appeal of an Adverse Benefit Determination shall be decided as soon as feasible, but no later than 72 hours after the Claims Administrator receives the request for review or Appeal. Pre - Service Claim s - A Pre - Service Claim shall be decided within 15 days after the Claims Administrator receives the C laim, although the review period may be extended an additional 15 days if necessary due to circumstances beyond the Claims Administrator ’s control. The c laimant will be notified within the original 15 - day period of the reason for the extension and the date the Claims Administrator expects to render its decision. If the C laimant does not follow a Health Benefit P ro gram’s procedures for filing a Pre - Service Claim , the Claims Administrator must notify the claimant within 5 days of the proper procedures for the claimant to complete the c laim. If the Claims Administrator cannot render a d ecision within 15 days because the c laimant has not provided suffic ient information to review the c laim, the notice of extension must describe the specific info rmation needed to complete the c laim. The c laimant will be given at least 45 days from receipt of this notice to provide the required information. The Claims Administrator has 15 days after it receives the information to render its decision. The Claims Administrator wil l decide an appeal of a denied Pre - Service Claim within 30 days after receiving the request for review; provided, if a Health Benefit P rog ram provides for two levels of a ppeal, the Claims Administrator shall decide each level of a ppeal within 15 days. Concurrent Care Claims - An Adverse Benefit Determination involvi ng Concurrent C are Claim will be made sufficiently in advance of any reduction in or ter mination of treatment to allow the claimant to appeal the Adverse Benefit Determination . If a course of t reatment involves Urgent C are, the c laimant’s request to extend the course of treatment will be decided as soon as possible, but not later than 24 hours after the Claims Administrator receives the request, provided that the request is made at least 24 hours prior to the expiration of treatment. Post - Service Claim s - A Post - Service Claim shall be decided within 30 days after the Claims Administrator receives the C laim. The Claims Administrator may extend the review period for an additional 15 days if necessary due to circumstances beyond the control of the Claims Administrator . The Claims Administrator will notif y the c laimant within the original 30 - day period of the reason for the extension and the date by which the Claims Administrator expects to render its decision. If the Claims Administrator cannot render a d ecision within 30 days because the c laimant has not provided sufficient information to determine whether, or to what extent, benefits are covered or payable under the Health Benefit P rogram, the notice of extension will describe the specific info rmation needed to complete the Claim. The c laimant will be given at least 45 days from receipt of the notice to provide the required information. The Claims Administrator has 15 days from the date of receiving such information to render its decision.

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