HMO products underwritten by HMO Colorado, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Connecticut: Anthem Health Plans, Inc. September 2019 Anthem Provider News and Important Updates - NevadaĪnthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. * If Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility. If you have questions regarding this amendment, please contact your Contracting Representative. This means claims submitted on or after Octowill be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service*. Notification was sent Jto providers of applicable networks and contracts.Įffective for all claims received by Anthem on or after October 1, 2019, all impacted contracts will require the submission of all professional claims within ninety (90) days of the date of service. In an effort to simplify processes, improve efficiencies, and better support coordination of care, we are changing all professional agreements to adopt a common time frame for the submission of claims to us. Timely receipt of medical claims for your patients, our members, helps our chronic condition care management programs work most effectively, and also plays a crucial role in our ability to share information to help you coordinate patient care. With that in mind, it is also our goal to help providers receive their Anthem payments quickly and efficiently. Additional Filing Timesīlue Cross’ Medicare Advantage plans, the Federal Employee Program (FEP), and the State Health Plan (SHP) have timely filing requirements for the submission of claims, which can differ from guidelines for our commercial plans. Therefore, we’ve provided the chart below, explaining timely filing guidelines for both original and corrected claims.Anthem Blue Cross and Blue Shield (Anthem) continues to look for ways to improve our processes and align with industry standards. This revised method for identifying a corrected claim’s time allowance for reconsideration is being applied to all corrected claims for our commercially-insured members claims processed by Blue Cross, from Februand forward. As of February 8, 2017, Blue Cross’ claims processing systems for commercially-insured and BlueCard eligible out-of-state members’ claims, now recognize the oldest date of service reported on a corrected claim as the beginning date for that corrected claim’s 24-month (730-day) eligibility for reconsideration. However, recently we made a change to our processing systems, based upon providers’ requests to better establish a more recognizable start date to identify the beginning and end of the 24-month time allowance for a corrected claim’s eligibility for review. We introduced this time limitation in January 2013, and since then our claims processing systems has recognized a corrected claim to be eligible for additional review, up to two-years following the date when the original claim was processed by Blue Cross. (Applicable to claims corrected for services provided to Blue Cross and Blue Shield of North Carolina’s commercially-insured and administrative services only members, and claims for non-Medicare Advantage BlueCard SM members from other Blue Cross and/or Blue Shield Plans.)īlue Cross and Blue Shield of North Carolina (Blue Cross) maintains a two-year (24-month) time limitation for the submission of corrected claims and adjustments, which is in alignment with the North Carolina Prompt Pay law. Non-Discrimination Policy and Accessibility Services.Get a Quote for Individual and Family PlansĪncillary and Specialty Benefits for Employees.Health Plans for Individuals and Families.
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