If the National Emergency were over on June 1, 2020, 60 days later is July 31, 2020. Outcome – The time to file this claim is suspended starting on March 1, 2020, until 60 days after the National Emergency is declared over. The claim entered day 179 of the 180-day timeline on Feb. Situation – (assume 180-day timely filing rule) – Service was rendered on Sept. 29, 2020, the claim is subject to denial. Outcome – The rules to suspend timely filing do not apply. Situation – (assume 180-day timely filing rule) – The time for a claim to fulfil the timely file rule expired on Feb. Timely filing limits may vary by state, product and employer groups. To help providers and individuals meet timely filing rules, the period from March 1, 2020, to 60 days after the announced end of the National Emergency will not count towards timely filing requirements. Call the number on our members’ ID card or your BCBSIL Provider Network Consultant (PNC) if you have any questions. We appreciate your cooperation as we update our systems and processes to comply with the latest rules. The date within which claimants may file a request for external review after receiving an adverse determination.The date within which claimants may file an appeal of adverse benefit determination.The date within which individuals may file a claim.In compliance with the guidelines, between March 1, 2020, and 60 days after the announced end of the National Emergency, the following periods and dates are suspended: This is for members of all fully insured and self-funded groups that are regulated by the Employee Retirement Income Security Act, including members participating in commercial fully-insured PPO, Blue Choice PPO SM and HMO plans. Blue Cross and Blue Shield of Illinois (BCBSIL) will follow these guidelines. 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.As a result of the National Emergency declared on March 1, 2020, the Employee Benefits Security Administration, Department of Labor, Internal Revenue Service and the Department of the Treasury extended certain timeframes to ease the burden of maintaining benefits and compliance with notice obligations. 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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