Here Denied Claim For Authorization In Contra Costa
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Submitting Claims The claim submission timeframe for Contra Costa Health Plan is 180 days from the date of service, or primary explanation of benefits (EOB), for both contracted and non-contracted providers. Claims received after 180 days will be denied for untimely filing.
Thorough documentation based on a respected clinical source is the best way to obtain preauthorization or appeal a denial. In addition to government sources such as AHRQ, it may be worth asking your most frequent payers what guidelines they use. Clearly document any deviation from evidence-based guidelines.
If you are: a person (this includes sole-proprietors) you may claim up to $12,500; if you are a Corporation, limited liability company or partnership, you may claim up to $6,250.
Ways to File a Grievance or Appeal Call Member Services, Monday – Friday, 8am – 5pm at 1-877-661-6230 (Option 2) (TTY 711). If you have a clinically urgent issue, you can also reach our 24 Hour Nurse Advice Line at 1-877-661-6230 (Option 1).
If your request for prior authorization is denied, then you and your patient will be notified about the denial. The first step is to understand the reason behind the denial, so contact the health insurance company to find out the problem. For example, a PA request for a medication might be rejected due to many reasons.
Denials for “Timely Filing” In medical billing, a timely filing limit is the timeframe within which a claim must be submitted to a payer. Different payers will have different timely filing limits; some payers allow 90 days for a claim to be filed, while others will allow as much as a year.
CCHP is the primary managed-care provider for Medi-Cal beneficiaries in Contra Costa and we also manage smaller plans for county employees and IHSS homecare workers. Our members have access to hundreds of family medicine doctors and specialists in our provider networks.
What are the timely filing requirements? Timely filing requirements are generally 90 days from the date of service. Non-network provider and secondary claims filing limit is 6 months from date of discharge or date of service.
If you are: a person (this includes sole-proprietors) you may claim up to $12,500; if you are a Corporation, limited liability company or partnership, you may claim up to $6,250.
Contact Us 925-957-2200. TTY: 711. 925-646-2566 (Fax) To send the DA's Office an email, please email DAOffice@contracostada Note: Do not use this email address for Discovery Requests. All Discovery Requests should be faxed to the appropriate Unit. Office locations and maps click here.
