Bcbs timely filing limit 20206/16/2023 If we make changes to our Terms of Use and you continue to use this Website or the Products you are implicitly agreeing to our Terms of Use. You should review this Agreement every time you use the Products because it is binding on you. WIS may revise this Agreement from time to time by updating this posting, with the new terms taking effect on the date of posting. In the event of any inconsistency between the WIS Privacy Policy, (the "WIS Privacy Policy"), and this Agreement, this Agreement shall control. Your continued use of the Products following the posting of any changes to this Agreement constitutes acceptance of those changes. ACCEPTANCE OF TERMS OF USEīy using the Website and/or downloading the Licensed Application, You signify that you have read, understand and agree to be bound by this Agreement. Blue Cross Blue Shield Global Core is a BCBSA program providing medical assistance and claims support services to eligible Blue Cross Blue Shield members. WIS and BCBSA are unaffiliated, independent companies. BCBSA has contracted with WIS to access and use their provider network for the Blue Cross Blue Shield Global Core program. This Terms of Use and End User License Agreement (this “Agreement”) describes the terms on which you (“You,” “Your,” or “End User” may access and use (i) the website located at that links to this Agreement (the “Website”) and (ii) the software application for mobile devices available for download on the Apple App Store and Google Play, including any user manuals or help files contained therein and any modifications, updates, revisions or enhancements thereto (the "Licensed Application” and together with the Website, the “Products”) which are owned and operated by Worldwide Insurance Services, LLC (Worldwide Services Insurance Agency, LLC in California and New York) (“WIS”), an independent licensee of the Blue Cross Blue Shield Association (“BCBSA”). 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.Terms of Use and End User License Agreement 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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