What if the Primary Carrier denies a claim for procedural reasons or if the member is not supplying requested information needed to pay the claim?
CareSource needs a copy of the primary carrier’s Explanation of Benefits denying the claim in order to process it within 365 days of our timely filing guidelines: • The member did not supply the requested information (For example, accident/injury questionnaire, full-time student questionnaire). • Procedural denial reasons (For example, timely filing, prior authorization, no referral from Primary Care Provider).
Related Questions
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