Billing RuleClaims submission and payment
Claims Provisions
Notice of Claims. When a claim arises for services you have already received, you should notify us of the Charges incurred in writing. This written notice of claim must be given within 20 days after any Charges incurred, which are covered by this section, or as soon as reasonably possible. Notice given to us by you or on behalf of you, at HealthPartners Insurance Company's principal office at HealthPartners Medical Claims, P.O. Box 21024, Eagan, MN 55121, with information sufficient to identify you and the service, is deemed notice.
Claim Forms. After receiving notice of claim, we will furnish a claim form for filing proof of loss. If this form is not received within 15 days after notice is given, you should submit written proof which documents the date and type of service, Provider name and itemized Charges, for which a claim is made.
Proof of Loss. You must submit an itemized bill which documents the date and type of service, Provider name and Charges for Covered Services. Bills must be submitted within 90 days after the date services were first received. Where this section provides for payments contingent upon a period of confinement, these 90 days shall begin at the end of the period for which we are liable. If you do not furnish proof within 90 days as required, benefits shall still be paid for that loss if (1) it was not reasonably possible to give proof within those 90 days, and (2) proof is furnished as soon as reasonably possible, but no later than one year after the end of those 90 days. Any bills for Covered Services must be submitted to HealthPartners within 15 months of incurring the Charges. Any bill received after 15 months from the date of service can be denied even if it is for a covered service, unless you were unable to submit the bill because you were legally incompetent.
Time of Payment of Claims. Unless otherwise provided by law, we will make payment promptly upon receipt of due written proof of loss. Benefits which are payable periodically during a period of continuing loss shall be payable on at least a monthly basis. We will notify you of our benefit determination if you have any remaining liability within 30 days of receipt of a completed claim.
Payment of Claims. All or any portion of any benefits provided on account of hospital, nursing, medical, dental or surgical services may, at our option, be paid directly to the hospital or Provider providing such services, but it is not required that the services be provided by a particular hospital or Provider.
At our option, all payments for claims may be made directly to the Provider of medical or dental services, rather than to the Enrollee, for claims incurred by a child, who is covered as a dependent of an Enrollee who has legal responsibility for the dependent's medical or dental care pursuant to a court order, provided we are informed of such order. This payment will discharge us from all further liability to the extent of the payment made.
Information. When you seek coverage for goods or services under this Policy, you grant us the right to collect and review any claims, eligibility, coordination of benefits, or medical or dental information necessary to make a proper determination of coverage under this Policy. In the event you fail to cooperate with or execute any documents necessary for our review of coverage requests, or coordination of benefits, or rights of subrogation, we reserve the right to refuse to grant coverage without receipt of necessary information.
Legal Action. No legal action may be taken on claims until 60 days after the bills have been submitted, nor more than three years after due proof of loss is required to be submitted.