Claims Processing. BCBSM will process Provider's Clean Claims submitted in accordance with this Agreement in a timely fashion.
Claims Processing. The carrier may conduct audits of claims being processed such as an analysis of patient histories and screening for duplicate payments in addition to the normal eligibility, benefit and charge verifications.
Claims Processing. Health Plan shall pay or deny Clean Claims within the time period set forth in Attachment C. Health Plan uses claims editing software programs to assist it in determining proper coding for provider claim reimbursement. Such software programs use industry standard coding criteria and incorporate guidelines established by CMS such as the National Correct Coding Initiative and the National Physician Fee Schedule Database, the AMA and Specialty Society correct coding guidelines, and state specific regulations. These software programs may result in claim edits for specific procedure code combinations.
Claims Processing. HEBP will receive claims, enter claims data into the claims processing system, determine whether benefits are payable in accordance with the Plan Administrator’s specifications, provide utilization review, apply allowable amount determinations, and administer coordination of benefits with other plans, when appropriate. HEBP will use its best efforts to correctly process claims and pay benefits in accordance with information provided by the Plan Administrator.
Claims Processing. In accordance with Section 5, process all claims arising under policies and contracts. Maintain claim documents, files and related information. Maintain and update beneficiary designations and life assignments. Control and maintain all draft and check stock, claim forms and other forms and documents incidental to claims processing. Maintain claims procedural manuals and other instructions. Monitor claims for possible fraud.
Claims Processing. PacifiCare shall establish and maintain standards, policies and procedures for the timely and accurate processing and payment of claims for Covered Services provided to Members (“Claims Processing Guidelines”). The Claims Processing Guidelines shall be maintained in accordance with the requirements of State and Federal Law and the Managed Care Plans.
Claims Processing. Contractor shall pay all claims submitted by contracting Providers in accordance with this section, unless the contracting Provider and Contractor have agreed in writing to an alternate payment schedule.
Claims Processing. Contractor shall:
Claims Processing. EquiTrust Life shall provide COUNTRY with all necessary information to properly address claims and EquiTrust Life shall execute COUNTRY's instructions regarding processing of claims and process and settle claims at the direction of COUNTRY. COUNTRY and EquiTrust Life will cooperate concerning disputed claims and contract interpretations brought to COUNTRY's attention by EquiTrust Life, a member or agent. The original copy of files sent to COUNTRY shall be retained by EquiTrust Life unless requested by COUNTRY.
Claims Processing. All claims will be submitted by the DVA/VHA medical facility and shall be processed as participating claims even if not so indicated on the claim form. Beneficiary submitted claims for care received at the DVA/VHA medical facility shall be denied using the EOB message: “Claims must be filed by the DVA/VHA Medical Facility.”
