Clover Health — New Jersey

Standard filing limit

90 days

Counted from

date of service

Appeal filing limit

65 days

Appeal window from

denial date

Notes

Clover Health standard timely filing limit is 90 days from the claim date of service for in-network providers, unless the Provider Services Agreement specifies otherwise; corrected claims within 90 days of the provider EOP. Appeals: standard pre-service and OON claim payment appeals may be made within 65 calendar days of the initial adverse determination notice (official Provider Manual).

Official website

https://www.cloverhealth.com/ ↗ (opens in a new tab)Copy●Verified · August 2026Verified Aug 22, 2026 · Official web pageView source ↗ (opens in a new tab)

Official website verified on 2026-08-22 (live fetch of https://www.cloverhealth.com/).

Member Services

1-888-778-1478Copy●Verified · August 2026Verified Aug 22, 2026 · Official web pageView source ↗ (opens in a new tab)

Clover Health member line published on the official providers page (TTY 711; 8 a.m.–8 p.m. — Oct 1–Mar 31 seven days/week, Apr 1–Sep 30 weekdays).

Every contact is individually source-tracked and shows the date it was last verified. A green “Verified” badge only appears when a source and verification date exist.

Authorization

Not yet published for this entry. Prior authorization requirements, channels and retro-authorization rules are published only when verified against a source.

Referrals

Not yet published for this entry. Referral requirements and retro-referral rules are published only when verified against a source.

Appeals

Not yet published for this entry. Appeal levels, filing channels and external-review options are published only when verified against a source.

Documentation requirements

Not yet published for this entry. Required documentation for appeals and additional-information requests is published only when verified against a source.

Common CARCs

19729

Common RARCs

MA119N29

Top reasons

Timely filing (CARC 29) — this plan documents a 90-day claim-filing window from the date of service; claims filed after the window are denied for exceeding the time limit (paired RARC MA119: provider-level adjustment for late claim filing).; Precertification / prior authorization / notification absent (CARC 197) — prior-authorization tools and eviCore PA guidelines are documented for covered services.