Submission of Claims Clause Samples

Submission of Claims. Either You or the Provider of service must claims benefits by sending ▇▇▇▇▇ properly completed claims forms itemizing the services or supplies received and the charges. These claim forms must be received by ▇▇▇▇▇ within one hundred eighty (180) from the date of services or supplies are received. If the claim is for an Out-of-Network Emergency Center or Urgent Care Center, these claim forms must be received by Oscar within one-hundred eighty (180) days from the date of services. ▇▇▇▇▇ will not be liable for benefits if a completed claim form is not furnished to Oscar within this time period, except in the absence of legal capacity. Claims forms must be used, canceled checks or receipts are not acceptable. ▇▇▇▇▇ follows all Department of Managed Health Care regulations when it comes to the payment of claims. Please submit Your claims as soon as possible in order to expedite payments. Any benefits determined to be due under this Agreement shall be paid within thirty (30) working days after We receive a complete written proof of loss and determination that benefits arepayable. When using an In-Network Provider they will bill Oscar directly for services rendered to You. In order for the Provider to submit a claim on Your behalf, You must give the Provider information necessary for the claim to be filed, such as Your Oscar ID card. Contracted providers must submit claims within one hundred eighty (180) calendar days following the dates of service, unless otherwise mandated by law or in the provider contract. A claim received after the one hundred eighty (180) days billing time limit may be subject to a denial. After You get Covered Services for Out-of-Network Emergency or Urgent Care, We must receive written notice of Your claim within one-hundred eighty (180) days, or as soon thereafter as reasonably possible. Either the Subscriber or Provider of service must claim benefits by sending Us properly completed claim forms itemizing the services or supplies received and the charges. These claim forms must be received by Us within one- hundred eighty (180) calendar days from the date the services or supplies are received. We will not be liable for benefits if We do not receive completed claim forms within this time period. Claim forms must be used; canceled checks or receipts are not acceptable. Claim forms are available by accessing Our web site at ▇▇▇.▇▇▇▇▇▇▇.▇▇▇ by calling the telephone number on the back of Your Identification Card or by writing to Us at the addr...

Submission of Claims. The Administrator shall prepare and submit any claim under the Insurance Policies in accordance with the requirements of the relevant Insurance Policy and otherwise with the usual procedures undertaken by a reasonable and prudent mortgage lender on behalf of the Mortgages Trustee as trustee for the Beneficiaries and shall comply with the other requirements of the insurer under the relevant Insurance Policy.

Submission of Claims. When Services are provided to a Covered Person, the Covered Person shall inform the Provider that he or she is a Covered Person of Company. In the case of a Participating Provider, the Covered Person is not responsible for filing the claim. In the case of a Non-Participating Provider, the Covered Person must file a claim for reimbursement unless the Provider agrees to file a claim on the Covered Person's behalf. Company shall not be obligated to make any payment until it receives, reviews and approves a claim for payment.

Submission of Claims. Subject to the rights and limitations set forth in this Agreement, every Settlement Class Member shall have the right to submit a claim for Settlement Benefits. A claim shall be a Valid Claim only if submitted on the Claim Form pursuant to, and in compliance with, the procedures set forth herein. Submission of a claim, regardless of whether it is determined to be a Valid Claim, shall confer no rights or obligations on any Party, any Settlement Class Member, or any other Person, except as expressly provided herein. 4.5.1 At the election of the Settlement Class Member, Claim Forms may be submitted in paper via first class mail or online via the Settlement Website. Claim Forms must be postmarked or submitted online no later than the Claim Filing Deadline. Claim Forms postmarked or submitted online after that date will not be Valid Claims. 4.5.2 Claim Forms submitted in paper via first class mail must include in a single mailing any Proof of Purchase submitted in connection with the claim. Proof of Purchase that is not submitted in the same mailing as the Claim Form will not be considered by the Claim Administrator. For Claim Forms that are submitted online, the Class Member shall have the opportunity to upload Proof of Purchase image files (e.g. jpg, tif, pdf) prior to submitting the claim, and to print a page immediately after the Claim Form has been submitted showing the information entered, the names of image files uploaded, and the date and time the Claim Form was submitted. 4.5.3 On the Claim Form, the Settlement Class Member must provide and certify the truth and accuracy of the following information under penalty of perjury, including by signing the Claim Form physically or by e- signature, or the claim will not be considered a Valid Claim by the Claim Administrator: (a) The Settlement Class Member’s name and mailing address; (b) The Settlement Class Member’s email address (unless the Settlement Class Member submits the Claim Form in paper via first class mail, in which case an email address is optional); (c) Which Covered Products were purchased during the Class Period; (d) The number of Covered Products purchased during the Class Period and the actual or approximate date(s) of purchase; (e) Whether the Settlement Class Member is submitting Proof of Purchase for any of the claimed purchases and, if so, the number of Covered Products for which the Settlement Class Member is submitting Proof of Purchase; (f) That the claimed purchases were not made for ...

Submission of Claims. Whenever any Proceeding shall occur as to which indemnification under this Agreement may be sought by the Indemnitee, the Indemnitee shall give the Corporation written notice thereof as promptly as reasonably practicable after the Indemnitee has actual knowledge of such Proceeding (an "Indemnification Notice"). The Indemnification Notice shall specify in reasonable detail the facts known to the Indemnitee giving rise to such Proceeding, the positions and allegations of the parties to such Proceeding and the factual bases therefor, and the amount or an estimate of the amount of Liabilities and Expenses reasonably expected to arise therefrom. A delay by the Indemnitee in providing such notice shall not relieve the Corporation from its obligations under this Agreement unless and only to the extent that the Corporation is materially and adversely affected by the delay. If the Indemnitee desires to personally retain the services of an attorney in connection with any Proceeding, the Indemnitee shall notify the Corporation of such desire in Indemnification Notice relating thereto, and such notice shall identify the counsel to be retained.

Submission of Claims a. Claims must be submitted electronically either through HIPAA Compliant Transaction Sets 820 – Premium Payment, 834 – Member Enrollment and Eligibility Maintenance, 835 – Remittance Advice, 837P – Professional claims, 837I – Institutional claims, or the LME/PIHP’s secure web based billing system. b. CONTRACTOR’s claims shall be compliant with the National Correct Coding Initiative effective at the date of service. c. Both parties shall be compliant with the requirements of the National Uniform Billing Committee. d. Claims for services must be submitted within ninety (90) days of the date of service or discharge (whichever is later), except in the instances denominated in subparagraph 8.e. below. All claims submitted past ninety (90) days of the date of service or discharge (whichever is later) will be denied and cannot be resubmitted except in the instances denominated in subparagraph 8.e. below. LME/PIHP is not responsible for processing or payment of claims that are submitted more than ninety (90) days after the date of service or discharge (whichever is later) except in the instances denominated in subparagraph 8.e. below. The date of receipt is the date the LME/PIHP receives the claim, as indicated on the electronic data records. e. CONTRACTOR may submit claims subsequent to the ninety (90) day limit in instances where the Enrollee has been retroactively enrolled in the Medicaid program or in the LME/PIHP program, or where the Enrollee has primary insurance which has not yet paid or denied its claim. In such instances, CONTRACTOR may bill the LME/PIHP within ninety (90) days of receipt of notice by the CONTRACTOR of the Enrollee’s eligibility for Medicaid and the LME/PIHP, or within 90 days of final action (including payment or denial) by the primary insurance or Medicare the date of service or discharge (whichever is later). f. If CONTRACTOR delays submission of the claims due to the coordination of benefits, subrogation of benefits or the determination of eligibility for benefits for the Enrollee, CONTRACTOR shall submit such claims within thirty (30) days of the date of the notice of determination of coverage or payment by the third party. g. If a claim is denied for reasons other than those stated above in subparagraph 7.e., and the CONTRACTOR wishes to resubmit the denied claim with additional information, CONTRACTOR must resubmit the claim within ninety (90) days after CONTRACTOR’s receipt of the denial. If the CONTRACTOR needs more than ninety...

Submission of Claims. Except as otherwise provided in Section 7.04, Participants shall make claims for reimbursements under the Plan in writing following such procedures, including deadlines and documentation requirements, and using such forms, as are prescribed by the Plan Administrator. Claims which are approved by the Plan Administrator shall be paid no less frequently than monthly or as soon thereafter as administratively feasible. Participants may file claims for expenses incurred during a Plan Year until the date specified in the Adoption Agreement following the end of the Plan Year.

Submission of Claims. Class Members must timely submit, by mail or online, a valid Claim Form substantially in the form attached as Exhibit A, as modified and/or approved by the Court, by the Claims Deadline. All Claim Forms must be postmarked or submitted to the Settlement Administrator, either in hard copy form or electronically via the Settlement Website, by the Claims Deadline and contain a valid Claim ID. Regardless of the manner in which it is submitted, a valid Claim Form means a Claim Form containing all required information, including a valid, unique claim identification number to be assigned by the Settlement Administrator, which is signed by a Class Member and is timely submitted. Any Claim Form which is not timely submitted shall be denied. In the event a Class Member submits a Claim Form by the Claims Deadline but the Claim Form is not complete, then the Settlement Administrator shall give such Class Member a reasonable opportunity to provide any requested missing information. For any Class Member who submits a Claim Form determined by the Settlement Administrator to be incomplete, the Settlement Administrator may mail a notice directly to such Class Member, notifying him or her of the missing information and providing him or her with an opportunity to cure (the “Cure Notice”). Class Members must cure incomplete claims on or before the Effective Date.

Submission of Claims. Doctor shall submit claims and other required information in the form and within the timeframes set forth in accordance with the procedures as stated in the applicable Plan Summary, or applicable Rules or Regulations. Claims submission procedures may be changed at any time at the discretion of CCMI, its designee or a health plan company. Standard claim forms (e.g. CMS 1500) shall be used for claims. Doctor understands that claims may be returned unpaid to Doctor for failure to follow correct submission procedures. Doctor further understands that an Enrollee may not be charged or billed for any charges denied because of late submission of claims by Doctor and that all such charges must be waived by Doctor.