![]() The inquirer asks whether the law prescribes a minimum amount of time by which an insurer must allow for the submission of claims by a provider. For various reasons (often times involving computer software limitations on either the submitting provider or insurer end) it is not always possible to submit the claim within the period specified in the contract, and the HMO/insurer refuses payment even though the claim is perfectly legitimate. There may be a limited exception granted where the delay in submitting a claim involves a coordination of benefits (COB). These contracts invariably include a requirement that the provider submit all claims for reimbursement to the HMO/insurer within a specified number of days (typically 90 or 180 days) after the date of service, and that failure to submit the claim within the required time period will result in denial of payment. The inquirer’s law firm represents a number of health care providers, including institutions and individual practitioners, and that as part of legal representation, the firm is called upon to review participating provider contracts between its clients and insurers, including HMOs. Accordingly, the Insurance Department will not opine on this question. Interpretations of the Abandoned Property Law are within the purview of the New York State Department of Audit and Control, not the New York State Insurance Department. If the contract between the provider and the insurer is silent on the matter of what would constitute a timely claim, then the insurer should provide for submission of a claim within a reasonable time.ģ. ![]() ![]() There is no minimum amount of time that an insurer, including an HMO, must allow for the submission of claims by a participating provider.Ģ. If an insurer, including an HMO, denies a claim by a participating health care provider as stale, would the amount that would otherwise be payable to the provider be payable to the State pursuant to the New York Abandoned Property Law? Conclusions:ġ. If there is no time limit for the submission of a claim set forth in the contract between the participating provider and the insurer, then how long does a participating provider have to submit a claim to the insurer?ģ. Is there a minimum amount of time that an insurer, including an HMO, must allow for the submission of claims by a participating provider?Ģ. ![]() Re: Health Insurance, Time Limit on Claim Submission Questions Presented:ġ. If you have any questions, email our Network Relations staff at Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility.The Office of General Counsel issued the following opinion on Jrepresenting the position of the New York State Insurance Department. ![]() This means claims submitted on or after Octowill be subject to a ninety (90) day timely filing requirement, and Blue Cross will refuse payment if submitted more than ninety (90) days after the date of service1. Notification was sent June 21, 2019, to providers of applicable networks and contracts.Įffective for all claims received by Anthem on or after October 1, 2019, all impacted contracts will require the submission of all professional claims within ninety (90) days of the date of service. In the effort to simplify our processes, align with industry standards, and better support coordination of care, Anthem Blue Cross (Anthem) is changing professional agreements to adopt a common time frame for the submission of claims. Guideline Updates / Reimbursement Policies. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |