Duplicate claims delay claims processing and create confusion for the member. For clean claims not processed within 30 days, interest is paid at the prevailing rate under Medicare regulations.ĭo not submit duplicate claims. All claim submissions must include the tax identification number (TIN), NPI, and applicable taxomomy of the rendering and billing provider(s).įor all Medicare claims, EmblemHealth adheres to the Centers for Medicare & Medicaid Services (CMS) rules and regulations for prompt claims payment: 95% of clean claims are processed within 30 days, and all other claims are processed within 60 days. Clean non-Medicare claims submitted electronically are processed within 30 days paper or facsimile clean non-Medicare claims are processed within 45 days in accordance with the New York State law for prompt payment of claims.
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