What types of adjustments are considered exception payments?

The following situations will constitute exception payments:

  • Non-contractual benefit payments and/or payment amounts in excess of annual/lifetime maximums 
  • Benefit renewal restrictions are not met or coverage maximums have been exceeded 
  • Location restrictions are not met 
  • Diagnostic restrictions are not met 
  • Annual exams provided prior to the renewal date 
  • Balance billing situations 

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