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  • Claims > Timely Submission

    Appropriate Timely Submissions When GHI Is Primary Carrier:

    • In-network claims: 365 days from date of service
    • Out-of-network claims: 18 months from date of service

      Appropriate Timely Submissions When GHI Is Secondary Carrier:

      • 365 days from the primary carrier’s EOB voucher date

        Appropriate Timely Submissions When HIP Is Primary Carrier: 

        • In-network claims: 365 days from date of service
        • Out-of-network claims: 365 days from date of service

          Appropriate Timely Submissions When HIP Is Secondary Carrier:

          • 365 days from the primary carrier’s EOB voucher date
          • Note: For Medicare Supplemental line of business, claims are exempt from the time limitation because of the length of time required for responses from primary payers. 

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          Glossary terms found on this page:

          An insurance company that either administers insurance or self-insures.

          An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.

          The date on which a service was rendered.

          A form sent to the enrollee after a claim for payment has been processed by the health plan. The form explains the action taken on that claim. This explanation usually includes the amount paid, the benefits available, reasons for denying payment and the claims appeal process. Also called Explanation of Benefits.

          The use of providers who participate in the health plan's provider network. Many benefit plans encourage enrollees to use network providers to reduce the enrollee's out-of-pocket expense.

          Specific circumstances or services listed in the contract for which benefits will be limited.

          Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

          A nationwide insurance program for the disabled and people age 65 and over, created by the 1965 amendments to the Social Security Act and operated under the provisions of the Act. It consists of two separate but coordinated programs, Part A and Part B.

          The group of physicians, hospital, and other medical care providers that a specific plan has contracted with to deliver medical services to its members.

          The use of health care providers who have not contracted with the health plan to provide services. Depending on the member's contract, out-of-network services may not be covered.

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