Ga. Comp. R. & Regs. R. 111-4-1-.11 - Claims
(1)
Filing
Claims. The Administrator shall coordinate the procedures for filing
claims with the TPA. Such procedures may not establish a liability period
greater than the maximum liability period set forth below. Claim forms shall be
designed and printed for the Member's and providers' use when
appropriate.
(2)
Maximum
Liability Period. All Claims of Benefits must be presented in writing to
the Administrator or TPA in accordance with the procedures established by the
Administrator and the TPA, which procedures may not permit payment of claims
submitted after twenty-four (24) calendar months following the month of service
in which the service was rendered. If any Claim for Benefits is presented to
the Administrator or TPA after two (2) years from the date the service was
rendered, benefits will not be owed or paid.
(3)
Unclaimed or Uncased Claim
Checks. All drafts issued on behalf of the Plan shall be void if not
presented and accepted by the drawer's bank within six (6) calendar months of
the date the draft was drawn. If the payee or Subscriber does not present the
draft or request a reissue of the draft for a period of seven (7) years from
the date the draft was drawn, the draft will be void and funds retained in the
appropriate trust Fund.
Notes
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