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. A backdate approval letter (new enrollments, affiliations or updates are not acceptable reasons for late filing).Claims that have been date-stamped by the fiscal agent or the Department and returned to the provider.The following are examples of acceptable proof of timely filing: If any of the scenarios listed below apply, but the claim in question is still within the 365-day window, a waiver is not needed and the provider only needs to resubmit the claim. How can a provider qualify for a timely waiver (override)? The previous ICN must be referenced on the claim, even if the claim is over 365 days. Providers must also resubmit claims every 60 days after the initial timely filing period (365 days from the DOS) to keep the claim within the timely filing period. What should providers do if the initial 365-day window for timely filing is expiring? Providers are required to submit the initial claim within 365 days, even if the result is a denial. What date is used when considering timely filing deadlines? A claim is considered filed when the fiscal agent documents receipt of the claim. A timely filing waiver or a previous Internal Control Number (ICN) is required if a claim is submitted beyond the 365-day timely filing period. Providers always have at least 365 days from the DOS to submit a claim. This is a permanent change, not a temporary extension. 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.What is the deadline for meeting timely filing requirements? Effective June 1, 2018, the Department of Health Care Policy & Financing (the Department) extended the timely filing period to 365 days from the date of service (DOS). 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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