Payment to Providers
The Plan will pay contracted Enhanced Care Management (ECM) providers for the provision of ECM services in accordance with the contract established between the Plan and ECM provider. The Plan shall pay 90% of all clean claims from practitioners who are individual or group practices or who practice in shared health facilities within 30 calendar days of date of receipt and 99% of all clean claims within 90 calendar days. The date of receipt shall be the date the Plan receives the claim, as indicated by its date stamp on the claim. The date of payment shall be the date on the check or other form of payment.
The ECM provider is eligible to receive payment when ECM is initiated for any given eligible ECM member. Remittance Advice and payment can either be sent via mail or electronically for faster receipt. For more information on claims submission and payment, refer to the provider operations manual in the Provider Library.