Hospital shall submit claims for Covered Health Services to Payer in a manner and format agreed to by Payer and Hospital, which may be an electronic format.  All information necessary to process the claims must be submitted by Hospital no more that one hundred twenty (120) days from the date of discharge.  Hospital and Payer agree that claims submitted after this time period may be denied for payment, unless the claim was returned to Hospital for further information or the claim involved Coordination of Benefits.

Note: Incorporate a reference to your states timely filing and timely payment statutes and administrative code, if applicable.