Common use of Timely Filing of Claims Clause in Contracts

Timely Filing of Claims. Provider must submit Provider’s claims within 95 days of the date of service. For a claim submitted by an institutional provider, the 95-day period does not begin until the date of discharge. For a claim for which coordination of benefits applies, the 95-day period does not begin for submission of the claim to the secondary payer until Provider receives notice-of the payment or denial from the primary payer. If Provider’s claim is not submitted within this time frame; Provider will not be reimbursed for the services and Provider may not charge Provider’s patient for them. If Provider’s failure to timely submit the claim is the result of an information systems failure or catastrophic event that substantially interferes with Provider’s normal business operations for more than two consecutive business days and about which Provider notifies the Texas Department of Insurance as required by 28 Tex. Admin. Code § 21.2819, United will extend the 95 day filing deadline by the number of days in which Provider’s business was unable to operate- In the event that Provider seeks and receives a waiver from United’s electronic filing requirements under 28 Tex. Admin. Code § 21,3701, Provider may submit non-electronic claims to the address shown in the Administrative Guide.

Timely Filing of Claims. Provider must submit Provider’s its claims within 95 days of the date of service. For a claim submitted by an institutional provider, ; the 95-day period does not begin until the date of discharge. For a claim for which coordination of benefits applies, the 95-day period does not begin for submission of the claim to the secondary payer until Provider receives notice-notice of the payment or denial from the primary payer. If Provider’s claim is not submitted within this time frame; , Provider will not be reimbursed for the services and Provider may not charge Provider’s its patient for themtherm. If Provider’s failure to timely submit the claim is the result of an information systems failure or a catastrophic event that substantially interferes with Provider’s normal business operations for more than two consecutive business days and about which Provider notifies the Texas Department of Insurance as required by 28 Tex. Admin. Code § §21.2819, United will extend the 95 day filing deadline by the number of days in which Provider’s business was unable to operate- operate. In the event that Provider seeks and receives a waiver from United’s electronic filing requirements under 28 Tex. Admin. Code § 21,370121.3701, Provider may submit non-electronic claims to the address shown in the Administrative Guide.