Timely Filing of Medical Claims

The time limit for filing a medical claim is six months from the date of service. If PEIA is the secondary insurer, the claim must be submitted within six months of the processing of the primary insurer’s explanation of benefits. Claims not submitted within the six month period will not be paid and will become the responsibility of the insured member. It is important for PEIA members to check the Explanation of Benefits forms received from HealthSmart following receipt of services to insure all claims are submitted by the provider within a timely period. Refer to page 51 of the Summary Plan Description for additional information.