提供者手册

索赔要求

及时性

All claims must be submitted within ninety (90) days of the discharge date or date of service. However, we encourage providers to submit claims on a monthly basis. Claims that are not submitted within the 90-day timeframe will not be considered for reimbursement. Carelon’s standards for claim turnaround time are to pay “clean claims” within 30 days of initial receipt. A clean claim is a claim received by Carelon with all required data present and valid that was adjudicated without having to obtain information from an external source.

供应商将通过支票和汇款通知书接收到有关付款或拒绝索赔的通知。如果无法确定会员的资格，提供商将通过代号为“ PAUNK”的代金券接收通知。会员名称将包含在此凭证中，以便提供商在必要时可以进行研究并重新提交。