Timely Filing of Accurate Claims

(a)This Section applies to Health Care Providers, as defined by this Article, duly certified, licensed, or organized and operating under the laws of Guam.

(b)All claims submitted for reimbursement must be submitted on a UB-92, HCFA 1500, ADA claim, or other billing document generally accepted by Health Plan Administrators. Claims may be submitted electronically if such a transmittal arrangement has been agreed to by the Health Plan Administrator.

(c)Health Care Providers shall be responsible for the accuracy of all claims filed. Duplicate claims, unbundled claims, or fee-for-service claims billed in a capitated arrangement, may not be submitted and cannot be considered for prompt payment in accordance with the provisions of this Article.

(d)Should a Health Care Provider fail to submit a response to a reasonable request for additional information on a contested or disputed claim, within forty-five

(45)days from the date of request for such additional information, no interest shall accrue to the claim or portion thereof eligible for payment. For purposes of this Subsection, should a Health Care Provider be a hospital, then such a hospital provider shall be allowed to submit a response to a reasonable request for additional information on a contested or disputed claim within ninety

(90)days from the date of request for such additional information.

(e)In order for a Health Care Provider to receive interest for the late payment of a claim as provided in § 9902, a claim for health services rendered must be submitted within forty-five

(45)days from the date the health service was provided.

(f)With the exception of those claims that involve the coordination of benefits, all claims for payment must be submitted by the Health Care Provider within ninety

(90)days from the date that health services were rendered. Any claim not submitted by the Health Care Provider within ninety

(90)days from the date that health services were rendered shall not be the financial responsibility of either the Health Plan Administrator or the patient.