Rule 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.Ga. Comp. R. & Regs. R. 111-4-1-.11
O.C.G.A. Sec. 20-2-881, 20-2-884, 20-2-890, 20-2-911, 20-2-917, 45-18-2, 45-18-6, 45-18-11.
Original Rule entitled "Health Maintenance Organizations" adopted. F. Apr. 18, 2005; eff. May 8, 2005.Repealed: New Rule entitled "Claims" adopted. F. Jan. 22, 2007; eff. Feb. 11, 2007.Repealed: New Rule of same title adopted. F. Apr. 14, 2010; eff. May 4, 2010.