UNTIMELY FILING – EXCEPTIONAL CIRCUMSTANCE

California HMOs

An insurer may not refuse to process a claim due solely to lack of timely filing unless the insurer can prove that it was substantially prejudiced by the late filing and where there is no question of the medical necessity of medical care by a physician, and there is no suggestion of fraud, gross negligence or willful misconduct, insurers cannot enforce a submission requirements.

This content is not viewable.

For full features, please log in or purchase the full program.