Timely Filing Requirement. All claims must be submitted to SHL within sixty (60) days from the date expenses were incurred, unless it shall be shown not to have been reasonably possible to give notice within the time limit, and that notice was furnished as soon as was reasonably possible. If the Insured authorizes payment directly to the Provider, a check will be mailed to that Provider. A check will be mailed directly to the Insured if direct payment to the Provider is not authorized. The Insured will receive an explanation of how the payment was determined.
Timely Filing Requirement. All claims must be submitted to HPN within sixty (60) days from the date expenses were incurred, unless it shall be shown not to have been reasonably possible to give notice within the time limit, and that notice was furnished as soon as was reasonably possible. If Member authorizes payment directly to the Provider, a check will be mailed to that Provider. A check will be mailed to the Member directly if payment directly to the Provider is not authorized. The Member will receive an explanation of how the payment was determined. No payments shall be made under this Plan with respect to any claim, including additions or corrections to a claim which has already been submitted, that is not received by HPN within twelve (12) months after the date Covered Services were provided. In no event will HPN pay more than HPN's Eligible Medical Expense for such services.
Timely Filing Requirement. For Indiana Medicaid claims, Provider must submit claims to Plan within ninety (90) days of the date of services. For other Products, Provider must submit claims to Plan within three hundred sixty-five (365) days of the date of service. For claims involving coordination of benefits or subrogation, Provider shall submit claims to Plan within three hundred sixty-five (365) days from the date of service or ninety (90) days after receipt of information of a primary carrier. Plan, or Plan’s designee, shall accept all corrections, additions, adjustments or appeal requests to a Clean Claim within ninety (90) calendar days of adjudication. Provider agrees that claims received after these time periods are ineligible for reimbursement. Provider’s right to appeal is provided in Plan Policies.
Timely Filing Requirement. Please see the Glossary Terms Section herein for a description of the terms used in this section. The following Appeals Procedures will be followed if the medical service site matter cannot be resolved at the site or if the concern involves the Adverse Benefit Determination of a Claim for Benefits. All Appeals will be adjudicated in a manner designed to ensure independence and impartiality on the part of the persons making the decision.
