IMPORTANT UPDATE: TIMELY CLAIM FILING REQUIREMENTS
For claims received on or after June 5th, MetroPlus will apply the timely filing provision found in each Participating Agreement. MetroPlus reserves the right to deny payment of any claims submitted outside the timeframe:
Medicaid, Medicare, Essential Plan, HARP, Special Needs and Family Health Plus Members – Claims received 90 days after the date of service or discharge
MetroPlus Gold & Gold Care Members, Exchange Members and Child Health Plus Members – Claims received 120 days after the date of service or discharge
Should MetroPlus request additional information in order to adjudicate the claims, please submit the requested information within 30 days from the requested date. Should MetroPlus be the secondary pay or the explanation of benefits from the primary pay or should be submitted within 60 days of receipt.Please note, the timely filing provision is as stated above unless the participation agreement states an alternative time frame to be applied.
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