![]() ![]() Note: Date stamps from other health benefit plans or insurance companies are not valid received dates for timely filing determination.The Authorization for Release of Information form is required according to the guidelines set forth in the Health Insurance Portability and Accountability Act (HIPAA), specifically 45 CFR § 164.508 of the HIPAA Regulations. Confirmation received date stamp that prints at the top/bottom of the page with the name of the sender.Primary payer claim payment/denial date as shown on the Explanation of Payment (EOP).The following date stamps may be used to determine date of receipt: ![]() The calendar day we receive a claim is the receipt date, whether in the mail or electronically. Medicaid (applies only to MA): Follow the instructions in the Member Financial Responsibility section of Chapter 11: Compensation. However, if the employer group benefit plan coverage were secondary to Medicare when the member developed ESRD, Medicare is the primary payer, and there is no 30-month period. After the 30 months elapse, Medicare is the primary payer. If a member has or develops ESRD while covered under an employer’s group benefit plan, the member must use the benefits of the plan for the first 30 months after becoming eligible for Medicare due to ESRD. An itemized bill is required to compute specific reinsurance calculations and to properly review reinsurance claims for covered services. If a submitted hospital claim does not identify the claim as having met the contracted reinsurance criteria, we process the claim at the appropriate rate in the Agreement.
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