Electronic Claims. Electronic Claims must be processed in adherence to information exchange and data management requirements specified in Section 4.17. As part of this Electronic Claims Management (ECM) function, the Contractor shall also provide on-line and phone-based capabilities to obtain Claims processing status information.
Electronic Claims. Provider shall prepare and submit to ILS Community Network or Managed Care Plan, according to the billing procedures established by ILS Community Network and Managed Care Plan, billing information for Enrollees who have received Covered Services from Provider. Provider shall use its best efforts to submit its claims for Covered Services electronically: (1) If a capitated Managed Care Plan, then to the capitated Managed Care Plan for compensation; (2) If a FFS, MMA or LTC Plan, then to the Agency or its Agent, unless the service is a transportation service for which the Managed Care Plan receives a capitation payment from the Agency. For such capitated Covered Services or transportation services, the Managed Care Plan shall require providers to look solely to the Managed Care Plan for payment.
Electronic Claims. Any Electronic Claim submitted by Provider shall be paid, denied or pended by Company within twenty-five (25) days from the date the Electronic Clean Claim is received by Company, unless (i) the claim is not payable under the terms of the Plan or (ii) just and reasonable grounds exist. Within five (5) working days of receipt of an Electronic Claim, Company shall review the entire claim and, if Company determines that the claim is not an accepted claim or Clean Claim, Company shall issue an exception report to Provider indicating all defects or reasons known at that time that the claim is not an accepted claim. If Provider submits a claim that is not an accepted claim, the claim shall be deemed to have been timely submitted for payment of Covered Services if Company fails to notify Provider, or the health care clearinghouse from which the claim was received, of all defects or reasons known at that time that the claim is not an accepted claim as required by state law. Company shall establish appropriate procedures, as approved by LDI, to assure that Provider receives a late payment adjustment equal to the amounts required by law if Provider is not paid within the statutory time frames. La. R.S. 22:1833.
Electronic Claims shall be treated as identical to paper-based Claims for the purposes of reporting.
Electronic Claims. Routing Process effective upon October 16, 2003. Amended June 13, 2002 EXHIBIT B ROYALTY FORMULA FOR SECTION 9 OF THE CONTROLLED AFFILIATE LICENSE AGREEMENT Controlled Affiliate will pay BCBSA a fee for this license in accordance with the following formula:
Electronic Claims. The Vendor shall offer electronic claims services. The agency retains the right to choose whether to use electronic claims and reports, or to communicate via optional print-based means offered by the Vendor, or a combination, e.g. transmitting claims to the Vendor electronically with periodic print reports for confirmation. Documentation on claims procedures/instructions shall be provided, e.g. manuals, reference guides, web documents, etc.
Electronic Claims. Routing Process effective upon the mandated date for implementation of the HIPAA standard transaction. AMENDED NOVEMBER 15 2001 EXHIBIT B ROYALTY FORMULA FOR SECTION 9 OF THE CONTROLLED AFFILIATE LICENSE AGREEMENT Controlled Affiliate will pay BCBSA a fee for this license in accordance with the following formula:
Electronic Claims. Routing Process — A Plan shall fully participate in the Electronic Claims Routing Process through compliance with all Electronic Claims Routing Process Policies and Provisions and all applicable Inter-Plan Programs Policies and Provisions. Standard 5: Participation in National Programs
Electronic Claims. Routing Process — A Controlled Affiliate shall fully participate in the Electronic Claims Routing Process through compliance with all Electronic Claims Routing Process Policies and Provisions and all applicable Inter-Plan Programs Policies and Provisions.
Electronic Claims. Routing Process effective upon October 16, 2003; and
