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#TIMELY FILING LIMITS BY PAYOR HOW TO#

If payment is not received within the 30-day time frame, the overpayment amount will be taken back through future claims payment.

Refunds must be received within thirty (30) days of receipt of notice, unless alternative arrangements are made in writing and accepted by ConnectiCare.

In the event that we notify you in writing that ConnectiCare has identified a payment error in an amount exceeding the amount due to you, you will be responsible for making the applicable refund.

Provide an explanation of why you are sending the refund.

Send a copy of the Explanation of Payment.

Complete a Standard Provider Refund Form.

If you would like ConnectiCare to take back the overpayment through future claims payment, or when you identify an overpayment prior to a notification from ConnectiCare: No requests for refunds beyond this time limit will be requested, unless the overpayment is due to fraudulent billing activity. We will identify and request reimbursement of overpayments within 18 months of the date the claim was paid. In the event that you receive an overpayment of claims, duplicate payment, or payment for claims that were reimbursed inaccurately, we request you refund the appropriate amount to ConnectiCare.

Denial letter, Explanation of Benefits, or take back notice from another carrier that was submitted within six (6) months of the date of denial.

Electronic vendor statement (“Acceptance Report by Providers”) showing that the data was successfully received by ConnectiCare (i.e., #R022).

When submitting the Provider Appeal Request Form, you must provide proof of timely filing. ( New York providers should refer to their contract as the filing limit in some contracts may vary.)įiling Limit Denial: Acceptable Documentation for AppealĪ computer printout from a provider’s own office system is not acceptable proof of timely filing of claims. ( The filing limit for some self-funded groups may vary.) For more information, contact Provider Services at 86 or 80. The filing limit for claims submission is 180 days from the date the services were rendered.

#TIMELY FILING LIMITS BY PAYOR HOW TO#

To discuss how to best connect your office with ConnectiCare using EDI, call 80.Computer Innovations | 20 | Capario | 80 |.Please see below for a list of clearinghouses with connectivity to ConnectiCare. Currently, ConnectiCare has relationships with several different clearinghouses. EDI clearinghouses are companies that can connect your office to several different payors or other organizations, including ConnectiCare. To accomplish this you will need some basic equipment, including a:Īn EDI connection is established with ConnectiCare through a clearinghouse.

To begin using EDI, an electronic connection must be established between your office and ConnectiCare. What will I need to use EDI with ConnectiCare? You can submit claims, receive remittance advice, and perform other transactions using EDI. If you have additional questions regarding EFT, please call 80.Įlectronic Data Interchange (EDI) InformationĮlectronic Data Interchange is a way of connecting your systems to our systems to exchange information quickly and efficiently, and typically at high volume.

If you are not yet registered, register today. To view your EOP statements online, simply sign in to your provider website account. You will no longer receive via mail a paper copy of your explanation of payment (EOP). Through your secure provider website account, your EOP is available online 3 days following the claims payment date.

Will EFT affect the way I receive my explanation of payment (EOP)? Yes, ConnectiCare coordinates EFT for claims for all product types. Will I receive EFT for all types of claims? Claims which are submitted in paper format may also be reimbursed via EFT. EFT is not dependent upon electronic claims submission. (ConnectiCare may also ask that you provide us with a spec sheet from your bank or a copy of a voided check.) In general, you will begin receiving payment electronically within 10 business days from the date we receive your completed form.ĭo I have to submit claims electronically in order to receive EFT? Simply fill out the Electronic Funds Transfer (EFT) Form and return it to ConnectiCare’s Finance Department. When you select to receive funds electronically, you can expect to receive your payment directly into your bank account within 48 hours of each claims payable date. EFT is a quick and easy way for participating providers to receive payment for the claims submitted to ConnectiCare.