A request for payment under a dental benefit plan; a statement listing services rendered, the dates of services, and itemization of costs. The completed request serves as the basis for payment of benefits.
Also known as fair claims practice regulations. Enacted state by state, prompt payment laws set standards for the prompt, fair and equitable settlements of insurance claims by requiring that a set amount of interest be paid on “clean claims” that are paid beyond the established timeframe. “Clean claim” means a claim for payment of covered health care expenses that is submitted to a payer on the carrier’s standard claim form using the most current published procedural codes, with all the required fields completed with information sufficient to adjudicate the claim in accordance with the payer’s published filing requirements. These laws need to be analyzed on a case by case basis to determine whether a lawsuit has to be filed by the state department of insurance.