Patient Administration
We realize that you perform administrative tasks in addition to tasks directly related to patient care.
To assist you with these tasks, we’ve consolidated the information below.
Member Grace Period
CGHC applies a federally mandated three month grace period to members who have advance premium tax credit (APTC). Members who do not have APTC, receive a one month grace period. If a member becomes delinquent in premium payments, we will identify this on the provider portal.
- For members receiving an APTC, one month after the start of a members grace period, we will suspend the member’s pharmacy benefits and pend medical claims for services rendered.
- For non-APTC members, starting day one of their grace period, CGHC will suspend the member’s pharmacy benefits and pend medical claims for services rendered during the members grace period.
- If members bring their account into good standing before the expiration of their grace period, pharmacy benefits will start again and pended claims will be processed. If the member does not bring their account current by the expiration of the grace period, the member is terminated due to nonpayment of premium and CGHC will deny all pended claims for no coverage.
Member Rights & Responsibilities
As a CGHC provider, you are required to respect the rights of our members. CGHC members are informed of their rights and responsibilities. Please review our members’ rights and responsibilities and ensure your practice is in compliance.