Frequently Asked Questions - Health Plan Claims and Billing
Q. Can a network provider bill me without first billing my health plan?
A. No. However, the provider is allowed to bill enrollees for copayments or coinsurance called for in your contract.
Q. What are "timely filing limits" and how do they affect me?
A. Each health plan enters into an agreement with a network of providers. The provider's contract may specify time limits for filing claims with the HMO. An enrollee cannot be held responsible for claims that a provider fails to submit to the health plan in a timely way.
Q. How quickly should claims be paid by the health plan?
A. Many claims are paid electronically within a few days, but in some circumstances it requires a longer period of time. By law, a claim that contains complete and correct information, as requested by the health plan, must be paid within 30 days after it is received by the health plan. If it is not paid within 30 days, the provider may charge interest to be paid by the health plan.
Back to Frequently Asked Questions
For more information, or to file a complaint, contact the MCS at 651-201-5100 or 1 800-657-3916.
