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. 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. The main rationale with this is that, if an individual goes outside the time limit for filing claims, a lot of insurance companies and majority of contributor agreements will restrict him from following the patient towards the denied balance.
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