Claim Payment

Clean Claim means a claim that has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstances requiring special treatment that prevents timely payments from being made on such claim.

(a) Ninety-five percent of the monthly volume of clean claims shall be paid within 30 days of receipt by the responsible carrier or agent of the carrier; and

(b) Ninety-five percent of the monthly volume of all claims shall be paid or denied within60 days of receipt by the responsible carrier or agent of the carrier, except as agreed to in writing by Cigna Behavioral Health, Inc. and PROVIDER on a claim-by-claim basis.

(c) Should Cigna Behavioral Health, Inc. fail to pay claims within the above standards, Cigna Behavioral Health, inc. shall apply interest on undenied and unpaid clean claims more than 61 days old at the rate of one percent per month.

(d) Cigna Behavioral Health, Inc. shall not deny payment to PROVIDER for a Covered Service that Cigna Behavioral Health, Inc. has prior-authorized under its written policies and procedures, except if the claim for the Covered Service was submitted fraudulently or negligently or PROVIDER was already paid for the Covered Service.