Audience
Zip code - drawer
County - drawer

Sign in

Sign in

Policy No: 119

Originally created: 11/01/2013

Section: Administrative

Last Reviewed: 04/01/2019

Last Revised: 04/01/2019

Approved: 04/18/2019

Effective: 05/01/2019

This policy applies to all providers and facilities.

Definitions

Associated Claims

Services that are related to or in support of services denied as non-covered, including investigational, cosmetic, not medically necessary services, and contract exclusions.  An example of an Associated Claim is the bill from an assistant surgeon for a cosmetic surgery.  The bill from the surgeon is considered the primary claim. The bill from the assistant surgeon is the associated claim.

Policy statement

Our health plan will deny reimbursement for claims associated with denied services, including investigational, cosmetic, not medically necessary services, and contract exclusions.  This applies to all services and claim types.  In addition, we will not allow providers or members to retain reimbursement from us for these associated claims. Responsibility for the costs associated with these claims will be assigned to the provider or member depending on the denial type.

Some examples of services that may be denied as associated claims include, but are not limited to services provided or performed:

  • By the provider or associate performing the denied service
  • By any assistant surgeon
  • By any anesthesia provider
  • By the facility where the service was performed
  • At the same time or during the same operative session (regardless of whether the service was billed)
  • Prior to or subsequent to an initial related denied service
  • By the provider without the required preauthorization

References

None

 

Cross References

None

Disclaimer

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.