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, AmeriHealth 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.

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