SUBMISSION OF AND ADJUSTMENTS TO CLAIMS FOR COVERED SERVICES Sample Clauses

SUBMISSION OF AND ADJUSTMENTS TO CLAIMS FOR COVERED SERVICES. BJC shall assure that BJC Providers submit claims for Member Covered Services to Plan in a manner and format prescribed by Plan. At Plan's request, BJC Provider may be required to submit such claims electronically in a manner and form agreed to by the parties and on at least 60 days notice to the BJC Provider. Member Covered Services claims must be received by Plan no more than 60 days from the date the Covered Services were rendered. BJC Provider agrees that claims received from and after 90 days from the date Member Covered Services were rendered may be rejected for payment, at Plan's discretion and may not be directly billed to the Member or any Payor; provided, however, that corrections or additions to such claims shall be considered by Plan if made within 30 days from BJC Provider's receipt of the initial claim payment. Unless otherwise directed by Plan, BJC shall assure that BJC Providers submit claims using current HCFA 1500 or UB92 forms with current HCPCS coding, if applicable, current ICD9 coding and current CPT coding. BJC Providers shall include in a claim the Member number and BJC Provider's Customary Charge for the Covered Services rendered to a Member during a single instance of service. If requested by Plan, BJC Provider shall also submit BJC Provider's Federal Tax I.D. number and/or other identifiers. Plan shall have the right to make corrective adjustments to any previous BJC Provider payment for a claim for Covered Services; provided, however, that any corrections shall be made either (1) within 6 months from receipt by Plan of such claim; (2) as part of an annual reconciliation procedure; or (3) at any time as part of a Plan audit of BJC's or BJC Provider's claims to the extent such claims adjustments arise out of billing errors, or improper, fraudulent or abusive billing practices.