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1. #BCBS TIMELY FILING LIMIT FOR CORRECTED CLAIMS PROFESSIONAL#
2. #BCBS TIMELY FILING LIMIT FOR CORRECTED CLAIMS FREE#

Physicians with questions are encouraged to contact Anthem Network Relations at a summary of California's unfair payment practices law, see " Know Your Rights: Identify and Report Unfair Payment Practices" More information on timeframes for claim submission can be found in “ Know Your Rights: Timely Filing Limitations” or in CMA health law library document #7511, “ Payment Denials by Managed Care Plans and IPAs.” available free to members on CMA’s Reimbursement Assistance page. As a reminder, California law states plans must allow a minimum of 180 days from the date of service for receipt of a claim for non-contracted providers. Mail Handlers Benefit Plan Timely Filing Limit: The claim must submit by December 31 of the year after the year patient received the service unless timely filing was prevented by administrative operations of the Government or legal incapacity. Remember, even if a physician fails to submit a claim on time, California law provides a “good cause” exception that requires payors to accept and adjudicate a claim if the physician demonstrates, upon appeal, “good cause” for the delay.Īnthem has clarified that the change does not affect non-contracting physicians. BCBS Florida timely filing: 12 Months from DOS. Other audits will be conducted as needed, such as diagnosis-related groups (DRG) validation, site of care, readmission, etc. CMA is assessing the issue to determine potential next steps. Blue Cross conducts audits in accordance with Medicare laws, rules and regulations. While the change in Anthem’s claim submission timeframe meets the minimum timeframe allowed by law for contracting physicians, the California Medical Association (CMA) has received several calls from physicians concerned that the June 21 letter of the material contract change was not sufficient advance notice, given the policy change impacts claims with July dates of service.Īs a result of CMA sponsored unfair payment practices law and the resulting regulations, plans are required to provide a minimum of 45 days prior written notice before instituting any changes or amendments about claim submission requirements.ĬMA raised this concern with Anthem, but the payor believes it provided sufficient advance notice.

However, as an example, the notice indicates that the change will impact claims with July dates of service if not submitted within 90 days. Ideally, wed like you to submit claims within 60 calendar days of the covered services, but no later than 365 calendar days.

Under the new requirement, all claims submitted on or after October 1, 2019, will be subject to the new 90 day filing requirement.

#BCBS TIMELY FILING LIMIT FOR CORRECTED CLAIMS PROFESSIONAL#

Anthem Blue Cross has notified physicians that it is amending sections of its Prudent Buyer Plan Participating Physician Agreement, significantly reducing the timely filing requirement for commercial and Medicare Advantage claims to 90 days from the date of service.Ĭurrently, Anthem requires physicians to submit all professional claims for commercial and Medicare Advantage plans within 365 days of the date of service.