Submission and Prompt Payment of Claims. County agrees to submit claims to CalOptima in such format as CalOptima may require (but at minimum the CMS forms 1500, UB 04 or other form as appropriate) within ninety (90) days after the services are rendered. CalOptima reserves the right to deny claims that are not submitted within ninety (90) days of the date of service, except where County bills a third party payor as primary. County agrees to refrain from duplicate billing any claims submitted to CalOptima, unless expressly approved by CalOptima in order to process coordination of benefit claims. CalOptima shall provide payment to County within forty-five (45) business days of CalOptima's receipt of a clean and uncontested claim from County, or, CalOptima will contest or deny County's claim within forty-five (45) business days following CalOptima's receipt thereof. ADDENDUM 2 – AMENDMENT IV ONECARE CONNECT (CAL MEDICONNECT PROGRAM) The following additional terms and conditions apply to items and services furnished to Members under the CalOptima Cal MediConnect Program. These terms and conditions are additive to those contained in the main Contract. In the event that these terms and conditions conflict with those in the main Contract, these terms and conditions shall prevail.
Submission and Prompt Payment of Claims. County agrees to submit claims to CalOptima in such format as CalOptima may require (but at minimum the CMS forms 1500, UB 04 or other form as appropriate) within ninety (90) days after the services are rendered. CalOptima reserves the right to deny claims that are not submitted within ninety (90) days of the date of service, except where County bills a third party payor as primary. County agrees to refrain from duplicate billing any claims submitted to CalOptima, unless expressly approved by CalOptima in order to process coordination of benefit claims. CalOptima shall provide payment to County within forty-five (45) business days of CalOptima's receipt of a clean and uncontested claim from County, or, CalOptima will contest or deny County's claim within forty-five (45) business days following CalOptima's receipt thereof.
