Gateway Health Plan Timely Filing Limit

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Provider Manual Gateway Health

Provider Gatewayhealth.com Get All

8 hours ago4.7 Timely Filing Policy 19 well managed health insurance. Gateway is organized as a free-standing corporation, operating separately from the hospitals, physician practices, pharmacies, mental healthfacilities and other providers. Today, more than 70 employers now offer health plan benefits through Gateway to nearly 30,000 employees and

Link: http://www.gatewayhealth.com/images/uploads/general/Provider_Manual_-_Gateway_Health.pdf

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Provider Reimbursement Policies Gateway Health

Provider Gatewayhealthplan.com Get All

8 hours ago2021 Medicare Plans 2021 Medicare Assured Plans - Gateway Health dropdown expander 2021 Medicare Assured Plans - Gateway Health dropdown expander. system. Most computers have this program installed. If it is not installed on your computer, you can download it for free from Adobe. Questions? Contact our Provider Services. Contact Us.

Link: https://www.gatewayhealthplan.com/provider/provider-resources/payment-policies

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PA Medical Assistance Gateway Health

Medical Gatewayhealthplan.com Get All

2 hours agoSince 1992, Gateway Health has focused on serving the members of our community who are eligible for Medical Assistance. Having the benefits of a Gateway Health Medicaid membership allows you access to better health plan solutions.

Link: https://www.gatewayhealthplan.com/medicaid

Category: Gateway health plan appeal formShow more

Gateway Health Your Partner for a Better, Healthier Life

Gateway Gatewayhealthplan.com Get All

4 hours agoAt Gateway Health, we believe in caring for the whole person in all communities where the need is greatest. Let Gateway Health be your partner to a better, healthier life. We are here when you need access to healthcare that focuses on quality care for your family.

Link: https://www.gatewayhealthplan.com/

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Provider COVID19 Updates Gateway Health

Provider Gatewayhealthplan.com Get All

1 hours agoProvider Updates Regarding Novel Coronavirus/COVID-19. Gateway Health is now part of the Highmark family! We will continue to provide health care to serve the whole you. You can find out how this partnership will impact you here.

Link: https://www.gatewayhealthplan.com/coronavirus/provider-covid-19-updates

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Grievance & Appeals Timeframes HPSM Providers

Grievance Hpsm.org Get All

5 hours agoGrievance and appeals processing. Standard. 30 calendar days. Expedited. 72 hours. If you have questions about the HPSM's Grievance and Appeals process, please contact HPSM Provider Services at …

Link: https://www.hpsm.org/provider/resources/grievance-appeals-process/response-timeframes

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Timely Filing Limit List in Medica Billing (2020) Medical

Timely Medicalbillingrcm.com Get All

9 hours agoWhat is timely filing limit in medical billing? Timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies.For example, if any patient getting services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement.

Link: https://medicalbillingrcm.com/timely-filing-limit-in-medical-billing/

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Claims Filing Instructions amerihealthcaritaspa.com

Claims Amerihealthcaritaspa.com Get All

1 hours agotimely filing guidelines if rejected for missing or invalid provider or member data. Note: Claims must be received by the EDI vendor by 9:00 p.m. in order to be transmitted to the Plan the next business

Link: https://www.amerihealthcaritaspa.com/pdf/provider/billing/claims-filing-guide.pdf

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Claims at Freedom Health Medicare Advantage

Claims Freedomhealth.com Get All

5 hours agoFreedom Health Claims Department P.O. Box 151348 Tampa, FL 33684. Claim Appeals. For claim denials regarding untimely filing, incidental procedures, bundling, unbundling, unlisted procedure codes, non-covered codes, etc. Claims must be submitted to Freedom Health within 90 days of date of denial from EOB. Mail claim appeals to: Freedom Health

Link: https://www.freedomhealth.com/provider/tools_and_resources/claims

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Welcome to HealthChoice Connect

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2 hours agoThe HealthChoice Tobacco-Free Attestation site is now open. With the annual Option Period underway, it's time for you to complete the Tobacco-Free Attestation requirements. If you or your dependents are enrolled in the HealthChoice High or Basic Plan and wish to remain enrolled for 2022, you must complete the attestation for Plan Year 2022.

Link: https://healthchoiceconnect.com/

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Claims Procedures UPMC Health Plan

Claims Upmchealthplan.com Get All

800-937-04381 hours agoUPMC Health Plan claims. • Have a computer with Internet access • Can download and install a free Active-X secure FTP add-on. • Complete testing with UPMC Health Plan. For questions about this process, contact UPMC Health Plan Web Services at 1-800-937-0438 from 8 a.m. to 4:30 p.m., Monday through Friday. Medicare Crossover

Link: https://www.upmchealthplan.com/docs/providers/2017_ProviderManual_H.pdf

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Select Administrative Services

Select Selectadministrativeservices.com Get All

5 hours agoMemorial Hospital Health Plan Members pay no out-of-pocket expense for their first virtual visit through 12/31/2021! American Rescue Plan Act of 2021 (ARPA) The American Rescue Plan Act of 2021 (“ARPA” or “the Act”) was signed by President Biden on March 11, 2021.

Link: https://www.selectadministrativeservices.com/

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Georgia Medicaid

Georgia Medicaid.georgia.gov Get All

9 hours agoMedicaid News. DCH is conducting stakeholder feedback sessions to solicit feedback and input on the DCH 2021‒2023 Quality Strategy on Friday, February 19, 2021 and Wednesday, February 24, 2021. For more information on the waiver submissions please visit the Patients First Act Webpage. The 30-day Extension of Postpartum Services 1115

Link: https://medicaid.georgia.gov/

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Gateway Health

Gateway Gatewayhealth.com Get All

9 hours agoGateway Health Alliance provides self-funded health plan management, with a focus on facilitating employer/provider partnerships.

Link: http://www.gatewayhealth.com/

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Chapter 6 Claims and Billing BCBSTX

Chapter Bcbstx.com Get All

877-560-80557 hours agofor untimely filing if those claims are not successfully submitted during the filing limit. After submitting electronic claims, do the following: •Monitor claim status on the provider portal or through the BCBSTX Customer Service Interactive Voice Response (IVR) at 877-560-8055. Please note that the IVR accepts either your billing National

Link: https://www.bcbstx.com/provider/pdf/chapter6_claims_and_billing.pdf

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Georgia Department of Public Health Billing Resource Manual

Georgia Dch.georgia.gov Get All

Just Now4.3 Filing Time Limits . 4.4 Appeals Process. PART II BILLING & CODING: METHODOLOGIES & RATES . Section 5 Immunization Services . 5.1 Methodologies 5.2 Health Check (HC) 5.3 Diagnostic, Screening, & Preventive Services (DSPS) 5.4 Medicare . 5.5 SHBP- UHC . 5.6 SHBP-CIGNA . 5.7 Blue Cross Blue Shield (BCBS) 5.8 AETNA . Section 6 Child Health

Link: https://dch.georgia.gov/sites/dch.georgia.gov/files/GA_Department_of_Public_Health_Billing_Resource_Manual.pdf

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2021 UnitedHealthcare Care Provider Administrative Guide

Care Uhcprovider.com Get All

Just Now2021 UnitedHealthcare Care Provider Administrative Guide i Welcome to UnitedHealthcare Welcome to the UnitedHealthcare Care Provider Administrative Guide …

Link: https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/2021-UnitedHealthcare-Administrative-Guide.pdf

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Provider Quick ReferenceGuide Coordinated Care Health

Provider Coordinatedcarehealth.com Get All

9 hours agoTimely Filing Guidelines: Providers will make best efforts to submit first time claims within 180 days of the date of service; however, claims will not be accepted for payment after 365 days from the date of service. When Coordinated Care is the secondary payer, claims must be

Link: https://www.coordinatedcarehealth.com/content/dam/centene/Coordinated Care/provider/PDFs/508-Provider-Quick-Reference-Guide.pdf

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2020 Provider Manual Gateway to Better Health

Provider Stlgbh.com Get All

8 hours agoGateway to Better Health Provider Manual (Revised 10/15/19) 3 SECTION 1- CLIENT CONDITIONS OF PARTICIPATION 1.1 INDIVIDUALS ELIGIBLE FOR GATEWAY TO BETTER HEALTH BENEFITS Gateway to Better Health benefits are available to individuals who are determined eligible by the local Family Support Division (FSD) office.

File Size: 786KB
Page Count: 11

Link: https://stlgbh.com/files/GBH_Provider_Manual.pdf

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Claims Submissions Humana

Claims Humana.com Get All

4 hours agoHealthcare providers also may file a claim by EDI through the clearinghouse of their choice. Some clearinghouses and vendors charge a service fee. Contact the clearinghouse for information. If submitting a claim to a clearinghouse, use the following payer IDs for Humana: Claims: 61101. Encounters: 61102.

Link: https://www.humana.com/provider/medical-resources/claims-payments/claims-submissions

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Devoted Health

Devoted Devoted.com Get All

4 hours agoDevoted Health Guides are here 8am to 8pm, Monday to Friday, and 8am to 5pm, Saturday. Call a Member Service Guide. 1-800-DEVOTED (338–6833) TTY 711 Disclaimers

Link: https://www.devoted.com/

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University of Utah Health Plans Provider Manual

Utah Uhealthplan.utah.edu Get All

4 hours agoUniversity Health Care Plus, Healthy Premier, Healthy Preferred, and Grand Valley Preferred: The timely filing limit for primary claims is 365 days from the date of service. The timely filing limit for secondary claims is 180 days from the primary payer’s EOB adjudication date.

Link: https://uhealthplan.utah.edu/for-providers/prov-manual/provider-manual.php

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Home London Health Administrators

Home Londonhealthusa.com Get All

2 hours agoCustom employee benefit plans with a personal touch. London Health is dedicated to you! Your employee benefit goals are our #1 priority. We are prepared to dedicate all resources to building personal service relationships with our clients and adapting our administration to help achieving your specific employee benefit goals.

Link: https://www.londonhealthusa.com/

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Department for Medicaid Services (DMS) Cabinet for

for Chfs.ky.gov Get All

1 hours agoThe U.S Department of Health and Human Services is making $25.5 billion available to Medicaid, Children’s Health Insurance Program and/or Medicare providers. The funds are available through the American Rescue Plan and the Provider Relief Fund. Providers can apply for assistance beginning Sept. 29.

Link: https://chfs.ky.gov/agencies/dms/Pages/default.aspx

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Billing & Claims McLaren Health Plan

Billing Mclarenhealthplan.org Get All

12.29.2359 hours ago

1. To ensure payment for eligible services, member eligibility should be verified before rendering care. Members are requested to present their McLaren Health Advantage identification card at each visit. If a member does not have their McLaren Health Advantage card with them, your office can verify eligibility and coverage by calling (888) 327‑0671. The member’s ID card will list the co-payment amount for office visits. Members are aware they are required to pay this amount and your office staff should collect that amount at each visit. Your office can bill the patient for non-covered services when they have been informed, prior to receiving the service, that it is not covered by their McLaren Health Advantage benefit. For further information on services that would not be covered, call Provider Services at (888) 327‑0671.

Link: https://www.mclarenhealthplan.org/mhcc-provider/billing-mhp

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Submit a claim Provider Priority Health

Submit Priorityhealth.com Get All

4 hours agoHow to: submit claims to Priority Health. We accept claims from out-of-state providers by mail or electronically. Paper claims should be mailed to: Priority Health Claims, P.O. Box 232, Grand Rapids, MI 49501. Electronic claims set up and payer ID information is available here.

Link: https://www.priorityhealth.com/provider/out-of-state-providers/medicare/submit-claim

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GEMGroup is now a part of Zenith American Solutions

GEMGroup Gemgroup.zenith-american.com Get All

(412) 471-28857 hours agoContact Us. Three Gateway Center 401 Liberty Ave., Ste 1200 Pittsburgh, PA 15222 Phone: (412) 471-2885 Toll Free: (800) 242-8923 Fax: (412) 471-2891

Link: https://gemgroup.zenith-american.com/

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Provider Manual

Provider Oklahoma.gov Get All

800-294-59798 hours agoCommercial (All non-Part D Plans) Prior Authorization toll-free 800-294-5979 Customer Care toll-free 877-720-9375 www.caremark.com. SilverScript (Medicare Part D) Prior Authorization toll-free 855-344-0930 Customer Care toll-free 866-275-5253 www.healthchoice.silverscript.com. ECHO Health Services. Toll-free 888-834-3511 www.providerpayments

Link: https://oklahoma.gov/omes/services/healthchoice/providers/provider-manual.html

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Claims Status and Provider Portal NaphCare

Claims Naphcare.com Get All

205.545.94701 hours agoTo check a claims status, enter NaphCare’s Provider Portal. The Provider Portal provides 24-hour access to: Claims status. EOP reprints. Other claims-related information. To access the Provider Portal, you will need to complete the Provider Portal Access Form. Email the completed form to [email protected] or via fax to 205.545.9470.

Link: https://www.naphcare.com/claims

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Sagamore Health Network, Inc Provider Reference Manual

Sagamore Sagamorehn.com Get All

(800) 969-36668 hours ago• Sagamore Health Network, Inc. is committed to working collaboratively with our Please feel free to contact them or one of our Provider Representatives at (800) 320- Gateway EDI Payor ID 35164 (800) 969-3666 www.gatewayedi.com McKesson (RelayHealth) Payor ID 4543

Link: http://www.sagamorehn.com/provider/pdfs/SHN_Provider_Manual_2011.pdf

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Provider Quick Reference Guide California Health & Wellness

Provider Cahealthwellness.com Get All

9 hours agoCalifornia Health and Wellness Attn: Claims Dispute PO Box 4080 Farmington, MO 63640-3835 Timely Filing – first time claim submission, not later than the sixth month following the month of service. Corrected Claims, Requests for reconsideration or claim disputes must be received within 365 days following the date of payment or the

Link: https://www.cahealthwellness.com/content/dam/centene/cahealthwellness/pdfs/CA-ProvQuickReferenceGuide2017.pdf

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Community Care Behavioral Health Organization

Community Ccbh.com Get All

Just NowCommunity Care helps you get the behavioral health treatment you need for better health and a higher quality of life. We are a health insurance company that has been helping people throughout Pennsylvania recover from mental health conditions and addiction for more than 20 …

Link: http://www.ccbh.com/

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State Guide to CMS Criteria for Medicaid Managed Care

State Medicaid.gov Get All

8 hours agoI.H.5 Timeframes for Filing Appeals 61 I.H.6 Process for Filing an Appeal or Expedited Appeal Request 61 I.H.7 Timeframes for Resolving Appeals and Expedited Appeals 63 I.H.8 Notice of Resolution for Appeals 64 I.H.9 Continuation of Benefits 65 I.H.10 Grievances 66 I.H.11 Grievance and Appeal Recordkeeping Requirements 67

Link: https://www.medicaid.gov/medicaid/downloads/mce-checklist-state-user-guide.pdf

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Rebill, Correct or Update Claims HPSM Providers

Correct Hpsm.org Get All

Just NowHealth Plan of San Mateo Attn: Claims Processing 801 Gateway Blvd., Suite 100 South San Francisco, CA 94080

Link: https://www.hpsm.org/provider/claims/update-claims

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Electronic Claims Submission MagnaCare

Claims Magnacare.com Get All

800.845.65928 hours agoElectronic claims submission Ease your administrative work by submitting claims electronically. To set up electronic claims submission for your office Contact Change Healthcare (formerly EMDEON): 800.845.6592 Once you’re set up Submit claims electronically to Change Healthcare and other electronic clearing houses using: Payor ID 11303 For any questions about electronic claims submission

Link: https://www.magnacare.com/who-we-serve/providers/electronic-claims-submission/

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2021 Tools & Resources (Provider) – Care N' Care

Care Cnchealthplan.com Get All

844-806-82161 hours agoClaims Status & Inquiries Provider Customer Service: 844-806-8216. Claims Payer ID: 66010 Mailing Address: Care N’ Care Claims P.O. Box 4375

Link: https://www.cnchealthplan.com/providers/tools-resources-2021/

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Forms For WPS Health Plan Providers WPS

WPS Wpshealth.com Get All

6 hours agoUse for timely filing denials, bundling disputes, provider reimbursement, and medical documentation required denials You should submit a claims reconsideration request when you believe a …

Link: https://www.wpshealth.com/resources/provider-resources/forms-documents.shtml

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Billing Information AmeriHealth Caritas Pennsylvania

Billing Amerihealthcaritaspa.com Get All

3 hours agoTimely filing limits. Initial claims: 180 days from date of service. Resubmissions and corrections: 365 days from date of service. Coordination of benefits submissions after primary payment: 60 days (when submitting an explanation of benefits (EOB) with a claim, the dates and the dollar amounts must all match to avoid a rejection of the claim).

Link: https://www.amerihealthcaritaspa.com/provider/billing/info.aspx

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Chapter 5 Claims Submission Unit 2: Claims Submission and

Claims Highmarkblueshield.com Get All

8 hours agoTimely Filing Timely filing is a Highmark Blue Shield requirement whereby a claim must be filed within a certain time period after the last date of service relating to such claim or the payment/denial of the primary payor, or it will be denied by Highmark. Per the timely filing policy, any claim not received within 365 days of the last date of

Link: https://www.highmarkblueshield.com/pdf_file/hbsom-chapter5-unit2.pdf

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FAQs help provide answers about your benefit plan EBMS

FAQs Ebms.com Get All

6 hours agoA: miBenefits provides enrolled members and their dependents with access to benefits and claims information, 24/7, from the convenience of their home or office. Enrolling is easy, and miBenefits provides access to the following: Real-time information on claims status. Electronic EOBs (Explanation of Benefits) to print or save. Benefit Summaries.

Link: https://www.ebms.com/faqs/

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Provider Manual For Health Care Providers UPMC Health Plan

Health Upmchealthplan.com Get All

888-499-69227 hours agoEmployer Group Services: 1-888-499-6922. TTY: 711. For Members. For Members. As a UPMC Health Plan member, you have access to much more than top-ranked care. Your plan includes online health tools, award-winning customer service, health and wellness programs, travel coverage, and many more benefits and services.

Link: https://www.upmchealthplan.com/providers/medical/resources/manuals/provider-manual.aspx

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MassHealth Billing and Claims Mass.gov

Billing Mass.gov Get All

Just NowMassHealth claims information for direct data entry (DDE) Billing Tips Billing Information MassHealth Coordination of Benefits (COB) List of Explanation of Benefit Codes Appearing on the Remittance Advice The ACA Operating Rules. See all 10. of MassHealth Billing and Claims.

Link: https://www.mass.gov/masshealth-billing-and-claims

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Aetna Better Health Of Virginia Timely Filing Life

Aetna Life-healthy.net Get All

1 hours agoAetna Better Health of West Virginia. Aetna Aetnabetterhealth.com Get All. 1 hours ago Aetna Better Health of WV, PO Box 67450, Phoenix, AZ 85082-7450 Timely filing for initial clean claim is 365 days from DOS Timely filing for corrected claims or documents requested for review is 120 d ays from the original remittance date.

Link: https://life-healthy.net/aetna-better-health-of-virginia-timely-filing/

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Quick Reference Guide Texas Children's Health Plan

Quick Texaschildrenshealthplan.org Get All

877-908-60235 hours agoTexas Children’s Health Plan Pharmacy Information. Navitus website: www.navitus.com Navitus toll free provider hotline: 1-877-908-6023 Navitus customer care: 1-866-333-2757. Provider Portal. Texas Children’s Health Plan’s new online portal offers you convenient 24-hour …

Link: https://www.texaschildrenshealthplan.org/for-providers/provider-resources/quick-reference-guide

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Community Plan Policies UHCprovider.com

Community Uhcprovider.com Get All

2 hours agoCommunity Plan Policies. These policies apply to UnitedHealthcare Community Plan benefit plans.

Link: https://www.uhcprovider.com/en/policies-protocols/comm-plan-medicaid-policies.html

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Claims CenCal Health Insurance Santa Barbara and San

Claims Cencalhealth.org Get All

6 hours agoElectronic: To find out more about submitting claims electronically to CenCal Health, please contact the EDI team at CenCal Health.. If you are currently submitting electronically to CenCal Health you can reference the CenCal 5010 Companion Guide, and the Trading Partner Worksheet.. Please email CenCal Health’s EDI Workgroup for further information.. File Transport Security

Link: https://www.cencalhealth.org/providers/claims/

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Contact Us HPSM

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650-616-00501 hours agoFor the safety all HPSM members and employees, and to comply with public health guidelines, HPSM will no longer host in-person meetings at our offices during the COVID-19 pandemic. 801 Gateway Blvd., Suite 100 South San Francisco, CA 94080. Phone: 650-616-0050 Fax: 650-616-0060 Ⓒ 2021 Health Plan of San Mateo

Link: https://www.hpsm.org/contact-us

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Frequently Asked Questions

What is gateway health insurance?

Gateway Health is a managed care company dedicated to partnering with employers in order to provide them with affordable, well managed health insurance. Gateway Health is organized as a free-standing corporation, operating separately from the hospitals, physician practices, pharmacies, mental healthfacilities and other providers.

What is the timely filing limit of HealthNet?

Healthnet Access TFL - Timely filing Limit: 6 months: HIP TFL - Timely filing Limit: Initial claims: 120 Days (Eff from 04/01/2019) When its secondary payer: 120 days from the primary carrier EOB date: Humana TFL - Timely filing Limit: Providers: 180 Days Facilities or Ancillary Provider: 90 Days: Keystone First TFL - Timely filing Limit: Initial claims: 180 Days

Is there a time limit to file a health insurance claim?

Every insurance company has a time window in which you can submit claims. If you file them later than the allowed time, you will be denied. For most major insurance companies, including Medicare and Medicaid, the filing limit is one year from the date of service.

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