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The Importance of Timely Filing For Claims Paid in Error

Posted on November 9, 2016

As we head into a new benefit year for many of our customers, it may be a good time to remind people about the importance of using the correct ID card during the transition time.

There are occasions where the new ID card may not have been received by a member. In addition, their “old” ID card may not be terminated right at the beginning of the year.  For example, for a January 1 renewal, the new group may still be in the process of being set up, and the former ID card has not been technically cancelled yet.

A member may be at the pharmacy on January 2nd, and their old card runs through with no problem.  A member may think they are all set, because the Rx ran through. However, the carrier will eventually catch this error in payment, and will send the member a bill for the cost of the Rx that was filled in error.

If members receive one of these bills asking for the payment to be refunded, it is important to act quickly and not ignore the bill.  There is a window of time to submit to the new carrier (known as “timely filing”).

If a member misses the filing deadline for the claim, it will be denied by the new carrier and the member will end up responsible for the entire bill.

Therefore, if you do receive a bill for a claim paid in error, please call your new carrier ASAP to discuss how to submit this to them for processing.  Acadia Benefits is also here to help should any of our customers experience this issue.

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