Plan Payment Time Frames Sample Clauses

Plan Payment Time Frames. Anthem, Plan or their designee and Provider, where required by statute, regulation or the Health Benefit Plan, shall comply with the requirements of the Colorado prompt payment legislation, as may be applicable, for payment of Clean Claims for Covered Services. In the event the Colorado prompt payment legislation is not applicable, Anthem shall require Plans or their designees to use commercially reasonable efforts to make payment or arrange for payment for all Clean Claims for Covered Services submitted by Provider within thirty (30) days for electronic claims and forty five (45) days for paper claims, exclusive of Claims that have been suspended due to the need to determine the extent of Plan's payment liability, if any, because of issues such as coordination of benefits, subrogation, eligibility for coverage, or Medical Necessity. 2.6.1 Where required by statute, regulation or the Health Benefit Plan, Anthem shall require Plans or their designees to make or arrange for prompt payment to Provider for Covered Services rendered to Covered Individuals. Such payment shall be made within thirty (30) days following receipt of a properly completed and submitted Clean Claim if submitted electronically and forty-five (45) days if submitted by hard copy. In the event additional information is required to appropriately process the Claim, Anthem will request such information within thirty (30) days of receipt of the Claim. Failure of Provider to provide the information requested within thirty (30) days of receipt of the request shall be grounds for denial of the Claim. Claims that are subject to payment by another carrier are not subject to the time limitation in this paragraph.

Plan Payment Time Frames. Anthem agrees to adjudicate Complete Claims submitted by Provider at the Anthem Rate provided herein within thirty (30) working days for indemnity or PPO Plan and forty-five (45) working days for HMO from receipt of Claims submitted unless the Claim, or portion thereof, is contested, in which case Provider shall be notified in writing within thirty (30) working days for indemnity or PPO Plan, or forty-five (45) working days for HMO. The term “contested” in this section has the same meaning as in the California Health & Safety Code, Section 1371, exclusive of Claims that have been suspended due to the need to determine Medical Necessity, or the extent of Plan’s payment liability, if any, because of issues such as coordination of benefits, subrogation or verification of coverage. The times frames set forth in this section shall not prevent or limit Plan’s right (as set forth in section 2.8), to recover all or any portion of payments made to the Provider when Plan determines that it has for any reason overpaid such Claims.

Plan Payment Time Frames. Anthem agrees to adjudicate Complete Claims submitted by Provider at the Anthem Rate provided herein within thirty (30) working days for indemnity or PPO Plan and forty-five (45) working days for HMO from receipt of Claims submitted unless the Claim, or portion thereof, is contested, in which case Provider shall be notified in writing within thirty (30) working days for indemnity or PPO Plan and forty-five (45) working days for HMO. The term "contested" in this section has the same meaning as in the California Health & Safety Code, Section 1371, exclusive of Claims that have been suspended due to the need to determine Medical Necessity, or the extent of Plan's payment liability, if any, because of issues such as coordination of benefits, subrogation or verification of coverage. The timeframes set forth in this section shall not prevent or limit Plan's right (as set forth in section 2.12 of this Attachment), to recover all or any portion of payments made to the Provider when Plan determines that it has for any reason overpaid such Claims. Certain confidential information contained in this document, marked by [**], has been omitted because American Well Corporation has determined that the information (i) is not material and (ii) is the type that American Well Corporation customarily and actually treats as private or confidential.

Plan Payment Time Frames. Unless otherwise set forth by statute, regulation, or the Commercial Business Member's Health Benefit Plan, Anthem shall require Plans or their designees to make payment or arrange for payment for all complete and accurate Claims for Commercial Business Covered Services submitted by Provider in accordance and within the time frames established by KRS 304.17A-702 or other applicable Regulatory Requirements. For Claims for Commercial Business Covered Services that are neither subject to KRS 304.17A-702, nor other applicable Regulatory Requirements, Anthem shall require Plans or their designees to make a good faith attempt to make payment or arrange for payment for all such Claims submitted by Provider within ninety (90) days, exclusive of Claims that have been suspended due to the need to determine Medical Necessity, or the extent of Plan's payment liability, if any, because of issues such as coordination of benefits, subrogation or verification of coverage.