Common use of Adjustment Requests Clause in Contracts

Adjustment Requests. If Provider believes a Claim has been improperly adjudicated for a Covered Service for which Provider timely submitted a Claim to Plan or its designee, Provider must submit a Claim Action Request Form ("CARF") or make a request for an adjustment with Plan or its designees within twelve (12) months from the date of Plan's payment or explanation of payment, unless otherwise set forth in the provider manual. The request must be submitted in accordance with Plan's CARF or payment inquiry process. Requests for CARF or adjustments submitted after this date may be denied for payment, and Provider will not be permitted to ▇▇▇▇ Anthem, Plan, or the Covered Individual for those services for which payment was denied.

Adjustment Requests. If Provider believes a Claim has been improperly adjudicated for a Covered Service for which Provider timely submitted a Claim to Plan or its designee, Provider must submit a Claim Action Request Form ("CARF") or make a request for an adjustment with Plan or its designees within twelve (12) months from the date of Plan's payment or explanation of payment, unless otherwise set forth in the provider manual. The request must be submitted in accordance with Plan's CARF or payment inquiry process. Requests for CARF or adjustments submitted after this date may be denied for payment, and Provider will not be permitted to ▇▇▇▇ bill Anthem, Plan, or the Covered Individual for those services for which payment was denied.