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Provider Manual

Clean Submission Reminder

Last Updated on January 24, 2019

Group and Direct Pay and some third party administrator (TPA) claims submitted with dates of services older than 180 days will be denied back to the practice and cannot be resubmitted for payment. Submitting claims to Security Health Plan as soon as possible after services occur is beneficial to both providers and members.

 

Claim filing timelines do not end with the original claim submission. If a practice submits the original claim to Security Health Plan within 180 days and Security Health Plan rejects or denies the claim back to the practice, the practice has 60 days from the date of rejection or notification of denial to resubmit a corrected claim to Security Health Plan. Resubmitted claims older than 60 days will be denied back to the practice and cannot be resubmitted again for payment.

 

The Affiliated Provider Agreement (contract) states:

  • Affiliated provider agrees to submit itemized claims to Plan within 180 days from the date the claim incurred or date of discharge. Plan is not responsible to Affiliated Provider for claims not submitted in a timely manner. In addition, affiliated provider may not bill, charge or seek remuneration from Participant for claims denied by Plan due to late submission.
  • In the event of Coordination of Benefits when Security Health Plan is secondary, claims must be submitted 180 days from the date the primary carrier has completed processing of the claim.