We shall notify a claimant of any deficiencies in a submitted claim not more than: (1) 30 days for a claim that is filed electronically; or (2) 45 days for a claim that is filed on paper; and describe any remedy necessary to establish a Clean Claim. Our failure to notify a claimant as required above establishes the submitted claim as a Clean Claim. If We fail to pay or deny a Clean Claim in the time required above, and We subsequently pay the claim, We shall pay the claimant interest, at the rate prescribed by Indiana law, on the allowable amount of the claim paid. Interest accrues beginning: (1) 31 days after the date the electronic claim is filed; or (2) 46 days after the date the paper claim is filed; and stops on the date the claim is paid. A ''Clean Claim'' means a claim submitted for payment that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. 2) Under the General Provisions , the following ''Internal and External Grievance Procedures'' provision is added: Internal and External Grievance Procedures INTERNAL GRIEVANCE PROCEDURE A ''grievance'' means any dissatisfaction expressed by or on behalf of a Covered Person regarding matters pertaining to the contractual relationship between: 1. a Covered Person and Us; or 2. the Policyholder and Us; and for which the Covered Person has a reasonable expectation that action will be taken to resolve or reconsider the matter that is the subject of dissatisfaction. A Covered Person may file a grievance orally or in writing. We shall make available to Covered Persons a toll free telephone number through which a grievance may be filed. A grievance is considered to be filed on the first date it is received, either by telephone or in writing. We have established procedures to assist Covered Persons in filing grievances. A Covered Person may designate a representative to file a grievance for the Covered Person and to represent the Covered Person in a grievance. Our grievance procedures include the following: 1. Acknowledgment of the grievance, given orally or in writing, to the Covered Person within 5 business days after receipt of the grievance. 2. Documentation of the substance of the grievance and any actions taken. 3. Notification to the Covered Person of the disposition of the grievance and the right to appeal. 4. Standards for timeliness in: a. responding to grievances; and b. providing notice to Covered Persons of the disposition of the grievance, and the right to appeal; that accommodate the clinical urgency of the situation. A grievance shall be resolved as expeditiously as possible, but not more than 20 business days after We receive all information reasonably necessary to complete the review. If We are unable to make a decision regarding the grievance within the 20 day period due to circumstances beyond Our control, We shall: 1. before the 20 th business day, notify the Covered Person in writing of the reason for the delay; and 2. issue a written decision regarding the grievance within an additional 10 business days. We shall notify a Covered Person in writing of the resolution of a grievance within 5 business days after completing an investigation. The grievance resolution notice must include the following: 1. A statement of the decision reached by Us. 2. A statement of the reasons, policies, and procedures that are the basis of the decision. 3. Notice of the Covered Person's right to appeal the decision. 4. The department, address, and telephone number through which a Covered Person may contact a qualified representative to obtain additional information about the decision or the right to appeal. Appeals of Grievance Decisions
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