She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.įor more information about how we use your data, please review our privacy policy. Charity Singleton CraigĬharity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. For use or reprint in your blog, website, or publication, please contact us at. Meanwhile Medicare’s filing limit remains 12 months from the date of service, and traditional Indiana Medicaid has a 180-day filing limit.įor more information about the change, review Anthem’s Provider Communications article “ Reminder: Changes to timely filing requirements coming in October.” Indiana’s Medicaid Managed Care Entities also have a 90-day filing limit. The new 90-day requirement reflects Anthem’s commitment to “simplify processes, improve efficiencies, and better support coordination of care.” The change also aligns Anthem with other commercial payers, including Aetna, Cigna, and United Healthcare, all of whom have 90-day timely filing limits for claims. If you need to submit a claim, please mail it in time to be received by Blue Cross NC within 18 months after the service was provided. “One hundred eighty days has been the Anthem Blue Cross and Blue Shield (Anthem) standard since 2007,” the payer explained. In 2016, when some professional and ancillary provider contracts inadvertently included a 90-day filing limit, Anthem issued a blanket correction, confirming their 180-day filing limit at that time. Beginning October 1, 2019, all claims will be subject to a 90-day filing requirement, and according to the payer, “Anthem will refuse payment if submitted more than 90 days after the date of service.”įor years, Anthem’s timely filing limit has been 180 days. 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.Anthem is changing their timely filing limit for professional claims. 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. 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. CMA is assessing the issue to determine potential next steps. 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. Under the new requirement, all claims submitted on or after October 1, 2019, will be subject to the new 90 day filing requirement. 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.
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