Common use of Electronic Claims Clause in Contracts

Electronic Claims. Provider shall prepare and submit to ILS Community Network or Managed Care Plan, according to the billing procedures established by ILS Community Network and Managed Care Plan, billing information for Enrollees who have received Covered Services from Provider. Provider shall use its best efforts to submit its claims for Covered Services electronically: (1) If a capitated Managed Care Plan, then to the capitated Managed Care Plan for compensation; (2) If a FFS, MMA or LTC Plan, then to the Agency or its Agent, unless the service is a transportation service for which the Managed Care Plan receives a capitation payment from the Agency. For such capitated Covered Services or transportation services, the Managed Care Plan shall require providers to look solely to the Managed Care Plan for payment.