Frequently Asked Questions - HMO Claims and Billing

Frequently Asked Questions - HMO Claims and Billing

Q. Can a network provider bill me without first billing my HMO?

A. No. However, the provider is allowed to bill enrollees for copayments or coinsurance called for in your contract. In addition, you may be billed for noncovered services if you agreed in advance to pay for these services.

Q. What are "timely filing limits" and how do they affect me?

A. Each HMO 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 HMO 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 HMO, must be paid within 30 days after it is received by the HMO. If it is not paid within 30 days, the provider may charge interest to be paid by the HMO.

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For more information, or to file a complaint, contact the MCS at 651-201-5100 or 1 800-657-3916.

Updated Tuesday, June 16, 2015 at 10:41AM