11/17/2023 0 Comments Bcbs timely filing limit for claims![]() ![]() ![]() If you have additional questions regarding this mass adjustment, please contact the Medicaid Expansion Provider Service Center at 1-83. While it should not be an issue for many claims, if the timely filing limit applies, a provider is advised to submit a claim correction with the primary carrier information, as well as a Not Otherwise Classified (NOC) note, located in loop 2400 SV101-7, stating the adjustment claim is related to CO45 denial for an additional review to be completed to bypass timely filing for this specific claim situation. Final submission of corrected claims that will be considered for adjudication (including replacement, resubmission, or void claims) must occur within 180 days from the adjustment finalization date. If a provider needs to then send in the primary carrier information, a claim correction needs to be submitted along with the primary carrier’s EOB. ![]() Providers impacted by this change will receive new remittances with the updated rejection information. The mass adjustment process has started and will be completed by September 30, 2023. Claims forms with attached itemized bill. Effective July 21, 2023, and upon mass adjustment, claims will receive a rejection of CO22. Claims must be submitted and received by us within 24 months after the service takes place to be eligible for benefits. It was determined through review that a different rejection should apply to assist in provider clarity regarding the scenario going back to January 2022. Note: It is important to verify your payer's timely filing requirement, (during the admission process), as some payers have a much shorter window to submit claims.Blue Cross Blue Shield of North Dakota (BCBSND) wants to inform providers of an upcoming Medicaid Expansion mass adjustment that will take place to correct claims for coordination of benefits (COB) needing primary carrier information, which were processed with a CO45 ANSI code denial. Therefore, BCBSNC participating providers are encouraged to file claims for BlueCard® patients without delay. However, members from other Blue Plans may have shorter filing time limitations applied depending on their individual benefit structure or State legal requirements. Note: Providers contracted with BCBSNC are allowed 180 days for claim submissions to be eligible for benefits release. Institutional/facility claims must be filed within 180 days of the member’s discharge date. Section 4.12.4 of BCBS ManualĬlaims for professional services provided to BlueCard® members having coverage with other Blue Plans (non-BCBSNC) must be submitted to BCBSNC within 180 days of providing service. Always verify the member’s benefits, including timely filing standards, through iLinkBlue. Corrected claims must be submitted no later than one year (12 months) from the date of service. TIMELY FILING Please Note: Not all member contracts/certificates follow the 15-month claims filing limit. Providers participating with BCBSNC are required to file FEP (Federal Employee Program) claims by December 31st of the calendar year, following the year in which the services were rendered or the date of discharge. Home health and hospice billing transactions, including claims, and adjustments must be submitted no later than 12 months, or 1 calendar year, after the date the services were furnished. Example: A claim has a From date of and a Through date of. Paper claims submitted over 90 days from. The "Through" date on claims will be used to determine the timely filing date. HIPAA mandates that any claim submitted beyond the timely filing limit must include a numeric delay reason code. The time limit for filing all Medicare fee-for-service claims (Part A and Part B claims) is 12 months, or 1 calendar year from the date services were furnished.
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