![]() Complete a Standard Provider Refund Form.If you would like ConnectiCare to take back the overpayment through future claims payment, or when you identify an overpayment prior to a notification from ConnectiCare: No requests for refunds beyond this time limit will be requested, unless the overpayment is due to fraudulent billing activity. We will identify and request reimbursement of overpayments within 18 months of the date the claim was paid. In the event that you receive an overpayment of claims, duplicate payment, or payment for claims that were reimbursed inaccurately, we request you refund the appropriate amount to ConnectiCare. Denial letter, Explanation of Benefits, or take back notice from another carrier that was submitted within six (6) months of the date of denial.Electronic vendor statement (“Acceptance Report by Providers”) showing that the data was successfully received by ConnectiCare (i.e., #R022).When submitting the Provider Appeal Request Form, you must provide proof of timely filing. ( New York providers should refer to their contract as the filing limit in some contracts may vary.)įiling Limit Denial: Acceptable Documentation for AppealĪ computer printout from a provider’s own office system is not acceptable proof of timely filing of claims. ( The filing limit for some self-funded groups may vary.) For more information, contact Provider Services at 86 or 80. The filing limit for claims submission is 180 days from the date the services were rendered. ![]()
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