Common use of Prompt Payment of Clean Claims Clause in Contracts

Prompt Payment of Clean Claims. United or Payer, as applicable, will make payment to Provider pursuant to the provisions of the Texas law. For instance, unless a longer time is permitted under applicable Texas law, not later than 30 days from the date United receive an electronic clean claim and not later than 45 days from the date United receives a non-electronic clean claim, United or Payer will either: pay the total amount of the claim in accordance with this Agreement; pay the portion of the claim that is not in dispute and notify Provider in writing why the remaining portion of the claim is not being paid; pay the total amount of the claim in accordance with this Agreement but notify Provider that the claim is subject to audit; request additional information from Provider within 30 days of receipt of a clean claim, and then pay or deny the claim within the time required by law after United receives that information or Provider fails to timely provide it; or notify Provider in writing why United or Payer will not pay the claim. If Provider submits claims that are not clean: • We will notify Provider within 30 days of receiving an electronic claim or within 45 days of receiving a non-electronic claim that it is not a clean claim; • You may be asked for additional information so that Provider’s claim may be adjudicated; or • Provider’s claim may be denied and Provider will be notified of the denial and the reason for it; or • United may in its discretion pay or have the claim paid by the other applicable Payer based on the information that you gave in addition to the information United has. A claim is complete or “clean” if it supplies all the information required by statute. The Administrative Guide contains additional important information about clean claims, an address to submit claims, a phone number and internet address where Provider can contact United with questions regarding claims Provider has submitted, information regarding any entity to whom United may have delegated claim payment functions, and the address and telephone number of any separate claims processing centers for specific types of claims or services. United or Payer may not refuse to process or pay an electronically submitted clean claim, because the claim is submitted together with or in a batch submission with a claim that is not a clean claim.

Prompt Payment of Clean Claims. United We or Payer, as applicable, a participating entity will make payment to Provider you pursuant to the provisions of the Texas law. For instance, unless a longer time is permitted under applicable Texas law, not later than 30 days from the date United we receive an electronic clean claim and not later than 45 days from the date United receives we receive a non-electronic clean claim, United we or Payer a participating entity will either: pay the total amount of the claim in accordance with this Agreementagreement; pay the portion of the claim that is not in dispute and notify Provider you in writing why the remaining portion of the claim is not being paid; pay the total amount of the claim in accordance with this Agreement agreement but notify Provider you that the claim is subject to audit; request additional information from Provider you within 30 days of receipt of a clean claim, and then pay or deny the claim within the time required by law after United receives we receive that information or Provider fails you fail to timely provide it; or notify Provider you in writing why United we or Payer the participating entity will not pay the claim. If Provider submits you submit claims that are not clean: • We will notify Provider you within 30 days of receiving an electronic claim or within 45 days of receiving a non-electronic claim that it is not a clean claim; • You may be asked for additional information so that Provider’s your claim may be adjudicated; or • Provider’s Your claim may be denied and Provider you will be notified of the denial and the reason for it; or • United We may in its our discretion pay or have the claim paid by the other applicable Payer participating entity based on the information that you gave in addition to the information United haswe have. A claim is complete or “clean” if it supplies all the information required by statute. The Administrative Guide contains additional important information about clean claims, an address to submit claims, a phone number and internet address where Provider you can contact United us with questions regarding claims Provider has you have submitted, information regarding any entity to whom United we may have delegated claim payment functions, and the address and telephone number of any separate claims processing centers for specific types of claims or services. United We or Payer a participating entity may not refuse to process or pay an electronically submitted clean claim, because the claim is submitted together with or in a batch submission with a claim that is not a clean claim.