According to some contract terms, if an MCO does not pay a claim within the time limit specified in the contract, the provider may be able to:

Question

Quizplus · Accepted Answer

If an MCO fails to pay a claim within the agreed-upon time frame, the provider may be entitled to charge the usual and customary fee instead of the discounted fee. This is known as the "prompt payment" provision, and it is designed to ensure that providers are fairly compensated for their services in a timely manner. Billing the patient directly or terminating the MCO contract are not typically options in this situation, and legal action would only be pursued as a last resort.

According to Some Contract Terms, If an MCO Does Not