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ALERT: Stale Claims

According to the scheme rules, a member or provider has four months from the date of service in which to submit an account
before the account is deemed stale. The Scheme has 30 days from receipt of the claim in which to process an account and either pay the account or reject the account and notify the member/provider of this payment/rejection.

The member/provider has 60 days from the date of notification to query the outcome or submit an amended account. Failure to query or to submit an amended account within the 60-day period will result in the account not being reviewed.

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