Claims Filing Clause Samples
Claims Filing. Participating Dentist shall file, at no charge, cost or expense to Delta Dental or the Covered Enrollee, claims for all completed Covered Services furnished to Covered Enrollees. Claims shall be submitted electronically and in accordance with the billing instructions of Delta Dental as communicated to Participating Dentist from time to time. Claim forms must be signed or submitted by the Participating Dentist. A Participating Dentist may not sign or submit a claim form on behalf of any other dentist, including, without limitation, any non-participating dentist. Claims submitted to Delta Dental more than ninety (90) days after the date the dental services were rendered will be disallowed by Delta Dental absent a showing of exceptional circumstances by Participating Dentist. Exceptional circumstances will be determined by Delta Dental in its sole discretion on a case-by-case basis, but exceptional circumstances may include, without limitation, claims that include coordination of benefits or require information from a third-party outside of the Participating Dentist’s control. In all events, claims must be completed and finalized within 365 days after the date the dental services were rendered or they will be disallowed. Without limiting the terms of Section 5 of these Uniform Regulations, a disallowed claim may not be billed to the Covered Enrollee.
Claims Filing. Participating Dentists shall file claims for all completed Covered Services furnished to Covered Persons at no charge to Delta Dental or the Covered Person. Claims shall be submitted in accordance with the billing instructions of Delta Dental as communicated to Participating Dentist from time to time. These billing instructions may include pretreatment review of certain procedures prior to the providing of such Covered Services. Participating Dentists shall not require the Covered Persons to prepay any portion of Covered Services except the deductible, coinsurance or copayment, if any. Claim forms must be signed or submitted by the Participating Dentist. A Participating Dentist may not sign or submit a claim form on behalf of any other dentist, including Non-Participating Dentists. Delta Dental may disallow payment of a claim submitted more than 365 days after the date Covered Services were rendered.
Claims Filing. Participating Dentists shall file claims for all Covered Services furnished to Covered Enrollees at no charge to Delta Dental or the Covered Enrollee. Claims shall be submitted in accordance with the billing instructions of Delta Dental as communicated to Participating Dentist from time to time. Claim forms must be signed or submitted by the Participating Dentist. A Participating Dentist may not sign or submit a claim form on behalf of any other dentist.
Claims Filing. If for any reason a claim for benefits under this Plan is denied by the Board, the Board shall deliver to the claimant a written explanation setting forth the specific reasons for the denial, pertinent references to the Plan section on which the denial is based, such other data as may be pertinent and information on the procedures to be followed by the claimant in obtaining a review of his or her claim, all written in a manner calculated to be understood by the claimant. The Company’s explanation shall be delivered to the claimant within 90 days of the date the claim is filed. For this purpose, the claimant’s claim shall be deemed filed when presented in writing to the Board.
Claims Filing. We will file claims for primary and secondary insurance plans with which we are contracted. We do not file with more than 2 insurers per claim. We accept the contractual write-off based on your primary insurance. Once we have received instruction from your insurance company, you will receive a bill for any outstanding balance. You will then be responsible for that balance.