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Contract – Medicare Provider & Insurer – Administrative Exhaustion – Claim Denials
By: Teresa Bruno, Opinions Editor//June 16, 2017//
Contract – Medicare Provider & Insurer – Administrative Exhaustion – Claim Denials
By: Teresa Bruno, Opinions Editor//June 16, 2017//
Listen to this articleUpstate Lung & Critical Care Specialists, P.C. v. Care Improvement Plus Practitioners, LLC (Lawyers Weekly No. 002-154-17, 8 pp.) (Mary Geiger Lewis, J.) 7:15-cv-04801; D.S.C.
Holding: Although the parties’ contract required plaintiff to follow defendant’s appeal process for denied claims before litigating such claims, it is unclear when or even whether defendant actually denied certain claims and triggered the 60-day period for plaintiff to appeal such denials. Without clear evidence of the actual dates of the denials of plaintiff’s claims, the court cannot determine whether plaintiff exhausted its administrative remedies.
Defendant’s motion to dismiss is denied.
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