![]() 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 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. More claims filing information is published in the BCBSMT Provider Manual.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. If the services are provided in Montana submit claims to: Timeliness Requirement When you provide covered services to a Blue Shield member, you must submit your claims to Blue Shield within 12 months of the date of service (s) unless otherwise stated by contract. If you print our online form, you must print it in color so that our optical character scanner can "read" the form.ĭental providers may use the Blue Cross and Blue Shield of Montana (BCBSMT) Dental Claim Form to receive compensation for services. 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. Many claims must be filed directly with the appropriate network in which case their electronic payor ID should be used. Hospitals and facilities should complete the UB-04 claim form to receive compensation for medical services. Outcome The rules to suspend timely filing do not apply. However, make sure to follow claim filing directions on the back of the member’s ID card. If you print our online form, you must print it in color so that our optical character scanner can "read" the form. The CMS-1500 is available at most office supply stores. Professional Providers should use the CMS-1500 form to be compensated. Other online options of Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) are also available.Have additional E-Commerce questions? Contact our Electronic Commerce Center by emailing Registered providers access Availity Software by clicking here. NDC Billing Guidelines NDC FAQs Submitting Electronic. Availity™ – To register with Availity or learn more about services available to BCBSMT providers, visit the Availity website, or call Availity Client Services at 800-AVAILITY (282-4548). More claims filing information is published in the BCBSMT Provider Manual.Provider Claim Forms and Electronic Submission Claim Forms and Electronic Claim Submission
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