31.10.11.12

.12 Receipt of a Claim.

A. Each third-party payor shall:

(1) Date-stamp the claim with the date received, for a written claim; or

(2) Assign to the document a batch number that includes the date received for an electronic claim.

B. Each third-party payor shall maintain a written or electronic record of the date of receipt of a claim.

C. Except as provided in §E of this regulation, a claim is presumed to have been received by a third-party payor according to the date of receipt of the claim stated in the written or electronic record required under §B of this regulation.

D. Pursuant to a request for claim receipt verification by a health care practitioner, hospital, or person entitled to reimbursement, a third-party payor shall provide within 5 working days verification of the date of claim receipt as stated in the written or electronic record, either in:

(1) Electronic form, if the request was for electronic verification; or

(2) Written form, including microfilm, if the request was for written verification.

E. A claim is presumed to have been received by a third-party payor:

(1) 3 working days from the date the submitting health care practitioner, hospital, or person entitled to reimbursement placed the claim in the U.S. mail, if the health care practitioner, hospital, or person entitled to reimbursement maintains the stamped certificate of mailing for the claim; or

(2) On the date recorded by the courier, if the claim was delivered by courier.