Common use of Timely Submission of Claims Clause in Contracts

Timely Submission of Claims. Provider shall submit complete claims to Blue Shield for Covered Services furnished to Members no later than twelve (12) months from the date such Covered Services were furnished by Provider or, if Blue Shield is not the primary payor under the coordination of benefits rules described in Section 3.6 hereof, the date payment or denial is received by Provider from the primary payor. If Provider fails to submit a claim for Covered Services within the time-frames set forth in this Section, Blue Shield may deny payment of the claim. In such event, Provider waives its right to any remedies and to pursue the claim further, and may not initiate a demand for arbitration or other legal action against Blue Shield or pursue the Member for additional payment; provided, however, that Blue Shield shall, upon submission of a Provider Appeal by Provider, consider good cause for late submission of a claim denied as untimely.