We know it is essential for you to receive payment promptly when you submit claims for your patients, and we have an obligation to our members to process claims promptly as well. There are times when we need additional information or documentation from you in order to complete processing of a claim, or to determine medical necessity, etc. We allow a reasonable amount of time for response to these requests before we deny the claim, typically up to 45 days for non-urgent requests.
We would like to remind you that as part of your provider agreement, you are required to respond to these types of requests for information in a timely manner. We appreciate your efforts to provide responses as quickly as possible to assist our efforts to provide the best service to you and our members.