Claims Adjudication and Payment Processing Requirements i. The MCOP must have the capacity to electronically accept and adjudicate all claims to final status (payment or denial). Information on claims submission procedures must be provided to non-contracting providers within 30 days of a request. The MCOP must inform providers of its ability to electronically process and adjudicate claims and the process for submission. Such information must be initiated by the MCOP and not only in response to provider requests. The MCOP must have a sufficient number of provider service representatives who are knowledgeable of the MCOP's claims system.
Claims Adjudication and Payment Processing Requirements
