Total Care Under One Roof
   
 

Policies and Procedures
bullet Providers Disclosures
bullet Claim Filing
Time Frame
bullet Submission
of Claim
bullet Complete Claim
Definition
bullet Claims Submission
Information
bullet Acknowledgement
of Claims
bullet Denied or
Contested Claims
bullet Reimbursement
of Claims
bullet Interest on
Late Payment
bullet Overpayment
of Claims
bullet Dispute Resolution
Process
bullet

Fee Schedule


Claim Filing Timeframe

Effective January 1, 2004, Serra Community Medical Clinic, Inc will accept claims from contracting providers if they are submitted within 120 calendar days from the date of service except as described below. If Serra Community Medical Clinic, Inc is not the primary payer under coordination of benefits (COB) rules, the claim submission period begins on the date the primary payer has paid or denied the claim. Claims not received within the timely filing period will be denied.

If the Provider Services Agreement (PSA) provides for a claim-filing deadline that is greater than 120 days, the longer timeframe will continue to apply unless and until the contract is amended. Providers contracting for the Medi-Cal line of business have 180 days from the last day of the month of service to submit initial Medi-Cal claims.

If a claim is denied for timely filing but the provider can demonstrate "good cause for delay" through the provider dispute resolution process, Serra Community Medical Clinic, Inc will accept and adjudicate the claim as if it had been submitted within the provider's claim filing timeframe