Claims Submission. We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.
Claims Submission. Claims must be submitted in a timely manner. A claim must be initially received and acknowledged within 12 months from the date of service (DOS) to be considered for reimbursement. Claims over one year old must have continuous active review. A claim replacement can be resubmitted within 12 months of the latest remittance advice date or other activity.
Claims Submission. Provider will submit Clean Claims for all Covered Services to BCBSM within one hundred eighty (180) days of the date of service and only for services performed personally by Provider.
Claims Submission. Provider will submit acceptable claims for Members’ Covered Services, and for Out-of-Panel Services unless otherwise specified by such member’s Alternative Delivery System, directly to BCBSM using BCBSM approved claim forms, direct data entry systems, tape-to-tape systems or such other methods as BCBSM may approve from time to time. An acceptable claim is one which complies with the requirements stated in published BCBSM administrative manuals or additional published guidelines and criteria. All claims shall be submitted within 180 days of the date(s) of service. Claims submitted more than 180 days after the date(s) of service, shall not be entitled to reimbursement from either BCBSM or a Member except as set forth in Addendum G, or except as may be provided in the standard reimbursement policies or contractual arrangements between an Alternative Delivery System and its members. Provider will endeavor to file complete and accurate claims and report overpayments in accordance with the Service Reporting and Claims Overpayment Policy attached as Addendum F.
Claims Submission. Provider shall submit claims electronically, following the procedures set forth in the Provider Manual. Payment by Blue Shield will be made only upon receipt of a complete claim submitted by Provider in accordance with this Agreement. Failure to submit claims electronically in accordance with the Provider Manual shall be deemed a material breach of the Agreement.
Claims Submission. Unless otherwise prohibited by federal or state law, Provider will submit Clean Claims for all Covered Services to BCBSM within twelve months of the date of service.
Claims Submission. PHARMACY shall submit Claims for Covered Prescription Services to Claims Processor, in the manner required hereunder, for adjudication, processing, and payment on behalf of the Plan Sponsors. PHARMACY agrees to submit all claims including those where the Member pays 100% of the cost share of the Covered Medication. PHARMACY shall ensure that transmitted Claims information to Claims Processor is in compliance with the then current requirements adopted by the NCPDP as set forth. PHARMACY shall ensure that Claims for Covered Prescription Services to Claims Processor are submitted via real time, point-of-sale communication. PHARMACY must submit Claims for reimbursement no later than ninety (90) days from the date Covered Prescription Services are rendered to Member. At no time shall PHARMACY be required to submit a Claim sooner than thirty (30) days from the date Covered Prescription Services are rendered to Member. PHARMACY shall ensure that all Claims are timely and cooperate with Claims Processor and/or SOUTHERN SCRIPTS in the adjudication and processing of Claims in a timely and efficient manner. PHARMACY must submit all required information for the Claim, which includes but is not limited to: the Member’s identification number; quantity of the medication dispensed; days supply dispensed, PHARMACY’s NCPDP provider and NPI number; the eleven
Claims Submission. PROVIDER agrees, throughout the term of this Agreement, to submit claims to Payor, or to Xxxxx's third party administrator (hereinafter "TPA") for reimbursement of services. All claims shall be submitted no later than thirty (30) days from the date of service. In the event PROVIDER is unable to submit bills within the specified time, the time for submission shall be extended as reasonably necessary, as agreed by both parties. Time may not exceed one year or the time period allowed under an applicable Benefit Agreement or Workers Comp Statutes, whichever is greater. Payor PROVIDER agrees to accept the fee schedule attached hereto as Exhibit A and hereby made a part hereof, as the applicable fee schedule for all services rendered by PROVIDER to Patients. PROVIDER agrees and acknowledges that the fee schedule contains a lower reimbursement for EPO Patients. PROVIDER further agrees that, the reimbursement paid by each Payor under the terms of the applicable Benefit Agreement, after applying the fee schedule in Exhibit A hereto, together with any coinsurance, co-payments and/or deductibles for which the Patient is responsible under the applicable Benefit Agreement, shall be payment in full for Health Care Services rendered by PROVIDER to Patients. Adjustments to bills submitted in a timely manner must be requested within 180 days after payment has been made or the matter will be considered closed and no further adjustments for either overpayment or underpayment of the bills will be considered.
Claims Submission. Participant and Preferred Provider will submit claims to CMS or ACO’s delegate for processing in accordance with Medicare’s applicable policies, including Medicare’s timely filing requirements, but may receive reimbursement from ACO, as outlined in this Section 2.0.
Claims Submission. Participants and Preferred Providers will submit claims to BCBSVT in accordance with timely filing rules and in accordance with BCBSVTs applicable policies, but will receive reimbursement for services within the Program, as outlined in this Section 2.0.
