Explanation of Grace Periods and Claim Processing During the Grace Period
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Describes Alliant Health SoloCare member premium grace periods and how claims are processed during those grace periods for members on- and off-Marketplace and for those receiving Advanced Premium Tax Credits (APTC). Applies to SoloCare (Individual/Family) policyholders.
No material clinical or coverage changes in this revision.
Grace Period Claim Processing Rules
Grace period claim processing criteria
How claims are handled based on enrollment source and APTC status during grace periods:
Claims Outcomes and Deadlines
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Provider Claim Handling During Grace Periods
Provider claim handling during grace periods
During a member's premium grace period, claims received are pended with a 'soft' denial status and held for potential reprocessing; Alliant reviews grace‑period member payments weekly and will reprocess pended claims to apply member benefits if the member pays premiums bringing the account current. For members receiving APTC who purchased on the Marketplace, claims for months two and three of the three‑month grace are initially denied for non‑payment but remain eligible for reprocessing if the member pays the total premium due by the end of the third month; if not paid, those claims become the member's financial responsibility. If the grace period ends without payment, pended claims are reprocessed to reflect termination and denial.
- Claims during any grace period are initially pended ('soft' denial) and held rather than fully processed.
- Alliant reviews grace‑period accounts weekly to determine if payment was made and will reprocess pended claims when the account is brought current.
- Off‑Marketplace members and on‑Marketplace members without APTC: claims during the 31‑day grace are processed according to plan benefits.
- On‑Marketplace members receiving APTC: claims are processed during first month of grace; claims for months two and three are denied for non‑payment but eligible for reprocessing if total premium is paid by end of month three; if unpaid, those claims are member responsibility.
- If the grace period concludes without payment, pending claims are reprocessed to reflect member termination and denial.
Key Terms
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