Time to file claims. Claims shall be received by Subcontractor or Health Plan (as applicable) within the timeframe set forth in the Agreement but in no event shall Subcontractor or Health Plan impose a timeframe such that Subcontractor or Health Plan must receive claims from Provider less than 90 days from the date of service, or, in the event Health Plan is a secondary payer, in no event shall Subcontractor or Health Plan impose a timeframe such that Subcontractor or Health Plan must receive claims from Provider less than 90 days from the date Provider receives notice of adjudication from the primary payer. Provider may request an additional 30 days to submit a claim if good cause is shown and Subcontractor or Health Plan shall not unreasonably deny Provider’s request for an extension. Claims shall be submitted for Medicaid beneficiaries with retroactive eligibility in accordance with United’s policy on retroactive eligibility as specified in the Provider Administrative Guide.
Appears in 5 contracts
Samples: Downstream Provider, Downstream Provider, Behavioral Health Individual Participating Provider Agreement
