Back to Blog
Blue shield timely filing limit 20206/12/2023 How does timely filing apply to adjustments and voids? If a claim is an adjustment and the provider is returning money, or if the provider is requesting an adjustment that does not change the reimbursement amount, timely filing does not apply. What if Medicare is the primary payer and they processed the claim after the 365 days expired? Providers have an additional 120 days from a Medicare payment or denial and must include the Medicare EOB date on the claim. What is the 365-day rule? Claims with commercial insurance/TPL must be received within 365 days with no additional extension. Providers must keep the EOB and supporting documentation on file. Providers must include the Medicare or TPL EOB date on the claim. Do I need to continue attaching the Explanation of Benefits (EOB) to electronic claims? Providers who receive payment from Medicare or other insurance/Third Party Liability (TPL) no longer need to attach the EOB to the electronic claim. The Delayed Notification of Eligibility form can no longer be used, as providers must submit within 365 days. If the timely filing period expires because the provider is not aware that the member is Health First Colorado eligible, the fiscal agent is not authorized to override timely filing. It is not effective to rely solely on billing statements, collection notices, or collection agencies as the only means of obtaining eligibility and billing information. Verifying eligibility through the Provider Web Portal.Contacting the member by phone or by mail.Requesting billing information from the referring provider or facility where the member was seen.Reviewing past medical and accounting records for eligibility and billing information for services provided.Some examples of appropriate action include: Providers are expected to take appropriate and reasonable action to identify Health First Colorado eligibility in a timely manner. ![]() What if the member did not notify the provider of eligibility? If the issue is between the provider and the software vendor, billing agent or clearinghouse, this does not constitute an acceptable reason to be outside the timely filing period. What if the issue was with my vendor? Issues resulting in failure to transmit accurate and acceptable claims or failure to identify transmission errors in a timely manner must be addressed. The claim must be submitted, even if the result is a denial. Phone calls and other correspondence are not proof of timely filing. What if I contacted the Department or fiscal agent and I am still waiting for a response? Waiting for prior authorization or correspondence from the Department or the fiscal agent is not an acceptable reason for late filing. If there is an RA within the last 60 days, providers must reference the previous ICN. Can I attach a copy of my Remittance Advice (RA) as a timely extension? No. ![]() The fiscal agent does not accept attachments via batch submissions. Attachments should be submitted with the claim via the Provider Web Portal. Providers must enroll and submit claims within 365 days from the DOS.Ĭlaims that are not able to be submitted within the 365-day guideline, but have one (1) of the above documents attached to the submission will be put into suspended status and will be reviewed by the fiscal agent.
0 Comments
Read More
Leave a Reply. |