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The Patient Protection and Affordable Care Act, also known as Health Care
Reform, mandates a three-month grace period for individual members who receive
a premium subsidy from the government and are delinquent in paying their
portion of the premiums. Under this mandate, insurers are required to pay
medical claims received during the first 30 days of the grace period, but may
pend medical claims for services rendered to those members and their eligible
dependents during the second and third months of the grace period. Insurers are
also required to notify affected providers when one of these members enters the
grace period. If payment is not received by the end of the grace period, the
pended claims will be denied and the member's policy will be terminated.
To comply with the mandate, IBC will notify affected providers by mail upon
receipt of a claim for services rendered for a member who is within the second
or third month of the grace period. In addition, a new field called Advanced
Premium Tax Credit will display within the Eligibility and Benefits Inquiry
transaction on the NaviNet® web portal to show providers when a
member is in the grace period and provide a status of the member's claims.
Look for additional information regarding the 90-Day Grace Period in future
editions of Partners in Health Update.
NaviNet® is a registered trademark of
NaviNet, Inc., an independent company.