Please utilize the HMO Medicare Quick Reference Guide to ensure correct claim submission. This guide also provides additional information regarding how to file claim disputes, Appeals and Grievances and a list of contracted delegated providers.
Providers are encouraged to check that all claims are submitted using proper coding and billing procedures to prevent rejections.
Providers are also encouraged to use electronic claim submission whenever it’s possible to expedite billing and payment.
Claims Submission Time Frames
Medicare Advantage In-network providers: The timely filing limit for the Plan is 180 days. Please check your contract to ensure you are filing claims within your contracted time frame.
Medicare Advantage Out-of-network providers: The Plan follows CMS guidelines.