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Billing Procedures | Requirements

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In the event that Hospital shall bill for services using an electronic format, such format shall be compliant with ANSI ASC X.12 837N Electronic Data Interchange (EDI) protocols.
In the event of unforeseen circumstances (i.e., loss of key billing staff, delayed computer conversions, fires, floods, or other force majeure), Health Plan and other Payers shall grant a perfunctory leniency of an additional 45-60 days upon written request.

Health Plan and other Payers shall grant one perfunctory leniency per Hospital/per year in which any claims previously denied for being presented in excess of timely filing limits may be reconsidered for payment.  Such claims shall not be granted leniency for dates of services in excess of one hundred eighty (180) days from the date of the leniency request.

Be sure to specify which DRG or  coding reference system is expected. Internationally, 18 DRG varieties are in use, and 4 of them are in the USA.  Also specify which version of ICD will be used to report diagnoses.