Submission and Adjudication of Medicaid Claims Sample Clauses

Submission and Adjudication of Medicaid Claims. Unless otherwise instructed, or required by Regulatory Requirements, Provider shall submit Claims to Plan, using appropriate and current Coded Service Identifier(s), within three hundred and sixty five (365) days from the date the Health Services are rendered or Plan may refuse payment. If Plan is the secondary payor, the day period will not begin until Provider receives notification of primary payor's responsibility. 3.1.1 Provider agrees to provide to Anthem, unless otherwise instructed, at no cost to Anthem, Plan or the Medicaid Member, all information necessary for Plan to determine its payment liability. Such information includes, without limitation, accurate and Clean Claims for Covered Services. Once Anthem determines Plan has any payment liability, all Clean Claims will be paid in accordance with the terms and conditions of a Medicaid Member's Health Benefit Plan, the PCS, Article VIII herein, and the provider manual(s). 3.1.2 Provider agrees to submit Claims in a format consistent with industry standards and acceptable to Plan either (a) electronically through electronic data interchange ("EDI"), or (b) if electronic submission is not available, utilizing paper forms as defined by the National Uniform Claim Committee ("NUCC"). 3.1.3 If Anthem or Plan asks for additional information so that Plan may process the Claim, Provider must provide that information within sixty (60) days, or before the expiration of the three hundred and sixty five (365) day period referenced in section 3.1 above, whichever is longer. 3.1.4 Anthem shall adjudicate a Clean Claim, in accordance with, and within the time frames under, the Regulatory Requirements applicable to Plan's Medicaid Program(s).