Common use of Prompt Claim Payments Clause in Contracts

Prompt Claim Payments. i. The Provider shall submit all claims to Alliance for processing and payments within one- hundred-eighty (180) calendar days from the date of covered service or discharge (whichever is later). However, the Provider’s failure to submit a claim within this time will not invalidate or reduce any claim if it was not reasonably possible for the Provider to submit the claim within that time. In such case, the claim should be submitted as soon as reasonably possible, and in no event, later than one (1) year from the time submittal of the claim is otherwise required. ii. Alliance shall within eighteen (18) Calendar Days of receiving a Medical Claim notify the provider whether the claim is clean or pend the claim and request from the provider all additional information needed to process the claim. iii. Alliance shall pay or deny a clean claim the lesser of thirty (30) Calendar Days of receipt of the claim or the first scheduled provider reimbursement cycle following adjudication. iv. A pended claim shall be paid or denied within thirty (30) Calendar Days of receipt of the requested additional information. If the requested additional information on claim is not submitted within ninety (90) days of the notice requesting the required additional information, Alliance shall deny the claim. v. Alliance shall reprocess claims in a timely and accurate manner as described in this provision (including interest and penalties if applicable). vi. If Alliance fails to pay a clean claim in full pursuant to this provision, the Alliance shall pay the Provider interest and penalties. Late Payments will bear interest at the annual rate of eighteen (18) percent beginning on the date following the day on which the claim should have been paid or was underpaid. vii. Failure to pay a clean claim within thirty (30) days of receipt will result in Alliance paying the Provider penalties equal to one (1) percent of the total amount of the claim per day beginning on the date following the day on which the claim should have been paid or was underpaid. viii. Alliance shall pay the interest and penalties from subsections vi. and vii. as provided in that subsection and shall not require the Provider to request the interest or the liquidated damages.

Prompt Claim Payments. i. The Provider shall submit all claims for a date of service before BH I/DD Tailored Plan Launch, to Alliance for processing and payments within one- one-hundred-eighty (180) calendar days from the date of covered service or discharge (whichever is later). The Provider shall submit all claims with a date of service on or after BH I/DD Tailored Plan Launch, to Alliance for processing and payments within three hundred sixty-five (365) Calendar Days from the date of covered service or discharge (whichever is later). However, the Provider’s failure to submit a claim within this time will not invalidate or reduce any claim if it was not reasonably possible for the Provider to submit the claim within that time. In such case, the claim should be submitted as soon as reasonably possible, and in no event, later than one (1) year from the time submittal of the claim is otherwise required.. For Medical claims (including behavioral health): ii. Alliance shall within eighteen (18) Calendar Days of receiving a Medical Claim notify the provider whether the claim is clean or pend the claim and request from the provider all additional information needed to process the claim. Alliance shall have the capability to request additional information via 277 Health Care Claim Request for Additional Information EDI transaction, via electronic means (including through a portal or email), and via mail. Alliance shall implement the capability for EDI 277 and electronic method (portal or email) no later than April 1, 2024, or later date if approved by the Department. iii. Alliance shall pay or deny a clean medical claim the lesser of thirty (30) Calendar Days of receipt of the claim or the first scheduled provider reimbursement cycle following adjudication. iv. A pended claim shall be paid or denied within thirty (30) Calendar Days of receipt of the requested additional information. If the requested additional information on claim is not submitted within ninety (90) days of the notice requesting the required additional information, Alliance shall deny the claim. v. Alliance shall reprocess claims in a timely and accurate manner as described in this provision (including interest and penalties if applicable). vi. If Alliance fails to pay a clean claim in full pursuant to this provision, the Alliance shall pay the Provider interest and penalties. Late Payments will bear interest at the annual rate of eighteen (18) percent beginning on the date following the day on which the claim should have been paid or was underpaid. vii. Failure to pay a clean claim within thirty (30) days of receipt will result in Alliance paying the Provider penalties equal to one (1) percent of the total amount of the claim per day beginning on the date following the day on which the claim should have been paid or was underpaid. viii. v. Alliance shall pay the interest and penalties from subsections vi. and vii. as provided in that subsection and shall not require the Provider to request the interest or the liquidated damages.

Prompt Claim Payments. i. The Provider shall submit all claims to Alliance the PIHP for processing and payments within one- one-hundred-eighty (180) calendar days from the date of covered service or discharge (whichever is later). However, the [Provider’s ’s] failure to submit a claim within this time will not invalidate or reduce any claim if it was not reasonably possible for the Provider to submit the claim within that time. In such case, the claim should be submitted as soon as reasonably possible, and in no event, later than one (1) year from the time submittal of the claim is otherwise required. ii. Alliance The PIHP shall within eighteen (18) Calendar Days of receiving a Medical Claim notify the provider whether the claim is clean or pend the claim and request from the provider all additional information needed to process the claim. iii. Alliance The PIHP shall pay or deny a clean claim the Clean Claim at lesser of thirty (30) Calendar Days of receipt of the claim Claim or the first scheduled provider reimbursement cycle following adjudication. iv. A medical pended claim Claim shall be paid or denied within thirty (30) Calendar Days of receipt of the requested additional information. If the requested additional information on claim a Claim is not submitted within ninety (90) days of the notice requesting the required additional information, Alliance the PIHP shall deny the claim. v. Alliance . The PIHP shall reprocess claims in a timely and accurate manner as described in this provision (including interest and penalties if applicable). vi. If Alliance the PIHP fails to pay a clean claim Clean Claim in full pursuant to this provision, the Alliance PIHP shall pay the Provider interest and penalties, to the extent required by law. Late Payments will bear interest at the annual rate of eighteen (18) percent beginning on the date following the day on which the claim Claim should have been paid or was underpaid. vii. Failure to pay a clean claim Clean Claim within thirty (30) days of receipt will result in Alliance the PIHP paying the Provider penalties equal to one (1) percent of the total amount of the claim Claim per day beginning on the date following the day on which the claim Claim should have been paid or was underpaid. viii. Alliance The PIHP shall pay the interest and penalties from subsections vi. (e) and vii. (f) as provided in that subsection and shall not require the Provider to request the interest or the liquidated damages.. (Attachment F.b.vii p. 323-324)