#Blue cross timely filing plus#
#Blue cross timely filing download#

Furthermore, if you aren’t familiar with all of your timely filing deadlines and you end up submitting a claim late, you’ll be dealing with denials-the kind that typically can’t be appealed (Pow! Blap! Ouch!). So, while you and your staff are treating patients, determining diagnosis codes, and submitting claims, you also have to keep track of all your contracted requirements. That sounds simple enough, but the tricky part isn’t submitting your claims within the designated time frame it’s knowing what that time frame is, and that’s because there’s no set standard among all payers. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. Timely filing is when you file a claim within a payer-determined time limit.

#Blue cross timely filing download#

Whoops! I mean, check out these timely filing tips and download the cheat sheet below for reference. So, how do you know when your claim submissions are early, on time, or downright late? Look to the Bat-Signal for guidance, of course. Because with claim submissions, lateness isn’t only unacceptable it also causes denials.

Or, maybe it’s because this rule truly applies in many situations-even in physical therapy billing. If you’re on time, you’re late.” Maybe I think that way because I have a Type A personality (holy organization, Batman). If you have a grievance, we ask you to first call customer service at 1-87 TTY 711.When it comes to punctuality, here’s my motto: “If you’re early, you’re on time. Failure to provide required notices that comply with CMS standards.Failure by the plan sponsor to provide required notices.Failure to forward your case for an independent review if we don’t give you a decision within the required timeframe.Failure to give you a decision within the required timeframe.You believe our notices and other written materials are hard to understand.You disagree with our decision not to expedite your request for an expedited coverage determination or redetermination.Cleanliness or condition of pharmacy or medical office.Disrespectful or rude behavior by pharmacists or other medical staff.Problems with how long you wait on the phone or in the pharmacy or medical office.Problems with the customer service you get.You feel that you’re being encouraged to leave (disenroll from) our plan.These issues may be reasons to file a grievance. When we add to the deadline, we will immediately let you know the reason(s) for the delay in writing. We may add to the timeframe by up to 14 calendar days if you request the extension, or if we justify a need for more information and the delay is in your best interest. You will get a written response to your Expedited Appeal as quickly as your case requires based on your health status, but no later than 72 hours after we receive your Expedited Appeal. You may file an Expedited Appeal over the phone by calling: You may file an Expedited Appeal in writing by sending a fax: You think that your covered services in a skilled nursing facility, home health or comprehensive outpatient rehabilitation facility is ending too soon.Coverage was denied and your health requires a quick response, or.When we add to the deadline, we will immediately let you know the reason(s) for the delay in writing.Įxpedited Appeals: You can ask for an expedited (fast) appeal if: You will get a written response to your appeal as quickly as your case requires based on your health status, but no later than 30 calendar days after we receive your appeal for medical service authorization or no later than 60 calendar days after we receive your appeal for payment. You may file an appeal in writing by sending a letter or fax: Blue Cross Medicare Advantage Dual Care (HMO SNP) SM Plan DocumentsĪppeals: You can ask for an appeal: If coverage or payment for an item or medical service is denied that you think should be covered.Blue Medicare Supplement Insurance SM Plan Documents.Blue Cross MedicareRx (PDP) SM Plan Documents.Blue Cross Medicare Advantage SM Plans Documents.

#Blue cross timely filing plus#

Blue Cross Medicare Advantage Dual Care Plus (HMO SNP) Plan.

Blue Medicare Supplement SM Insurance Plans.

Blue Cross Medicare Advantage Dual Care Plus (HMO SNP) SM Plan.

Blue Medicare Supplement Insurance SM Plans.Medicare Coverage Determination, Appeals and Grievances.Prior Authorization/Utilization Management.