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. 1. Upon receipt of a Claim, the Settlement Administrator shall review the Claim to determine whether the Claim meets all qualifications for payment set forth in this Settlement Agreement and shall notify Claimants who do not meet all qualifications. Within 60 days of receiving the Claim, the Settlement administrator shall notify the Claimant of:
a. Any deficiency in required documentation and shall reasonably specify what documents and/or information, if any, are still needed for claims determination;
b. The basis for the Settlement Administrator’s decision to deny a Claim, including the specific deficiencies in the Claim’s supporting documentation, if any;
c. The Claimant’s right to attempt to cure any deficiency, including any deficiency that led to the Settlement Administrator’s denial of a Claim; and
d. The initial determination of the amount owed for a Claim and/or notice that any determination as to Claims for payments from the Common Fund are going to be processed at the end of the claims period.
2. In response to receiving the written notice under section III.C.1, Claimants
a. Attempt to cure the deficiency stated as justification for denying a Claim, by submitting the information and/or documentation identified by the Settlement Administrator as lacking in the Claim, within 45 days of receipt of the written notice. The Settlement Administrators shall have 45 days from the date of receiving the cure attempt to provide written notice to the Claimant stating its final determination as to the approval or denial of the Claim, and shall notify the Claimant that they are entitled to appeal the determination to the Settlement Administrator at no additional cost; or
b. Accept the initial determination by the Settlement Administrator, which acceptance will be presumed if no cure attempt is received by the Settlement Administrators within 45 days of the date of the initial determination, at which point the Settlement Administrator will provide Claimants with their final determination as to the approval or denial of the Claim. The final determination letters shall notify Claimants that they are entitled to appeal the determination at no additional cost. Claimants who accept an initial determination, i.e., by communicating acceptance or not making a cure attempt, shall not be eligible to appeal the final determination.
3. In processing claims made by Claimants for Total Loss, the Settlement
4. For Claims that meet all requirements, the Settlement Administrator...
Claims Processing. The customer is informed that, in the event of wish- ing to file a claim, they can contact Kampaoh Agencia de Viajes S.L. at the following email address: xxxxx@xxxxxxx.xxx or by postal mail to Xxxxx Xx Xxx Xxxxx, 00 – Xxxxxxxx Xxxxxxxxxx Xx Xxx, Xxxxxx xx Guadaíra (Sevilla), Postal Code 41500. Likewise, and in compliance with the provisions of Article 40 of Law 7/2017 on alternative dispute resolution for consumer disputes, it is informed that Kampaoh Agencia de Viajes S.L. is not affiliated with any organization and/or entity for the alternative res- olution of such disputes. Notwithstanding the above, if you disagree with the solution adopted by us re- xxxxxxx your claim, you may contact the Consumer Arbitration Board of your respective Autonomous Com- munity and/or Municipality, as well as the Directorate- General for Tourism. In any case, it is informed that Kampaoh Agencia de Viajes S.L. will not participate in the arbitration procedure before the aforementioned entities. It is also informed that the limitation period for filing claims under Royal Legislative Decree 1/2007, of November 16, approving the consolidated text of the General Law for the Defense of Consumers and Users and other complementary laws, is two years.
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.”
Claims Processing. The Company shall bear all necessary administrative expenses and agrees that in the administration of the insurance plan, all claims shall be processed as expediently as possible. All matters concerning benefits provided under the insurance plan shall be governed by the terms and conditions of the insurance policy or policies purchased by the Company.
