First CHoice Agreement - Laserfiche WebLink

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Provider agrees to submit Clean Claims for Covered Services rendered to Participants on standard UB -04 and CMS -1500 forms, or successors to such forms. Completed UB -04 and CMS -1500 forms shall be submitted electronically or to the address set forth on the Participant's Benefit Plan identification card. Provider agrees to bill its usual and customary charges for the services rendered, to properly and accurately complete all required Provider, Participant, service, and procedure information on the claim form, and to accept payment in full as described in Section 2.14 of this Agreement. In submitting claims pursuant to this Section, Provider shall certify that all data submitted is accurate and truthful. 4.1.1 Claims shall be submitted at the earliest possible date after the date Covered Services are rendered 4.1.2 Payors are not required by FCHN to pay a claim if FCHN or the Payor receives the claim more than three -hundred -sixty-five (365) calendar days after the date the Covered Service was rendered, or sixty (60) calendar days after Provider first receives notice that Payor is a secondary payor under applicable coordination of benefits procedures, whichever shall be later. 4.1.3 Provider may submit, within the timely filing period described in Section 4.1.2 above, corrections to claims that were submitted with incomplete or invalid information. Incomplete means that information was missing from the claim, and invalid means that the information submitted was illogical, incorrect, or did not conform to the required claim format. Payors are not required by FCHN to pay corrected claims received by FCHN or any Payor more than three hundred sixty-five (365) calendar days after the date the Covered Service was rendered, or sixty (60) calendar days after Provider first receives notice that Payor is a secondary payor under applicable coordination of benefits procedures, whichever shall be later. 4.1.4 Provider agrees that requests for adjustments to claims that have been paid or denied, where the claim submittal failed to include a particular item or service or was otherwise in error, must be received by Payors within three hundred sixty-five (365) calendar days after the date the claim was denied or an initial payment was made for the claim. Payors are not required by FCHN to make payments for claims adjustment requests received after such time. Provider shall be under no obligation to refund incorrect claims payments requested by Payors or FCHN more than three hundred sixty-five (365) calendar days after the date an initial payment was made for the claim. 4.2 Payment of Claims FCHN shall require all Payors to pay Provider pursuant to Schedule B of this Agreement in accordance with the applicable Benefit Plan, as soon as practical, subject to the following minimum standards: 4.2.1 Ninety-five percent (95%) of the monthly volume of clean claims shall be paid within thirty (30) days of receipt; and 4.2.2 Ninety-five percent (95%) of the monthly volume of all claims shall be paid or denied within sixty (60) days of receipt, except as agreed to in writing by the parties on a claim -by -claim basis. 4.2.3 The receipt date of a claim is the date Payor receives either written or electronic notice of the claim. 4.2.4 Claims may be subject to code review software or correct coding edits. FCHN will request that Payors inform FCHN of code review or correct coding software and most frequent claims editing issues for FCHN as needed to facilitate Provider education and training. FCHN is not the guarantor of, or in any way responsible to Providers for, any claims payments, including charges and interest due if applicable. FCHN shall meet with Provider as needed to discuss and review FCHN Payors accounts receivable and to reasonably assist Provider in Provider's efforts to collect payments due and owing from any such Payor as determined by FCHN to be appropriate. These standards do not apply to claims about which there is substantial evidence of fraud or misrepresentation by Provider or Participants, or instances where the Payor has not been granted reasonable access to information under the Provider's control. FCHN-PRO-042016