Ambulance Services Providers Sample Clauses

Ambulance Services Providers. Providers of ambulance services agree to comply with State Program’s Clinical Coverage Policy No. 15, NC Medicaid Ambulance Services. 5.1 Payment. Consistent with N.C. Gen. Stat. § 58-3-225(f), Provider shall submit all claims with a date of service on or before June 30, 2023, to United for processing and payments within one-hundred- eighty (180) Calendar Days) from the date of covered service or discharge (whichever is later), except for pharmacy point of sale claims which shall be submitted within three-hundred sixty-five (365) Calendar Days of the date of the provision of care. When a Member is retroactively enrolled, United shall not limit the time in which claims may be submitted by Provider to fewer than one hundred eighty (180) Calendar Days from the date of enrollment for health care provider and health care provider facility claims and three hundred sixty-five (365) Calendar Days for pharmacy point of sale claims. i) For Medical claims (including behavioral health): a) United shall within 18 calendar days of receiving a medical claim notify Provider whether the claim is clean or pend the claim and request from Provider all additional information needed to process the claim. b) United shall pay or deny a clean medical claim at lesser of 30 calendar days of receipt of the claim or the first scheduled provider reimbursement cycle following adjudication. c) A medical pended claim shall be paid or denied within 30 calendar days of receipt of the requested additional information.