Business transparency

Understanding our procedures

To help you understand how we do business, see any of these links for more details about a few of our procedures:

Coordination of Benefits (COBs)

Drug Exception Time Frames and Enrollee Responsibilities

Enrollee Claims Submission

Enrollee Recoupment of overpayments

Explanation of Benefits (EOBs)

Additional resources

Grace period and claims pending

Machine readable information

Medical necessity and prior authorization timeframes and enrollee responsibilities

Out of network liability and balance billing

Retroactive denials

This information pertains only to our QHP (Qualified Health Plan) plans.