IL BCBS TIMELY FILING LIMT HOW TO

IL BCBS TIMELY FILING LIMT HOW TO

(See pages 95- 97 for information on how to obtain benefits from the Retail Pharmacy Program and the Specialty Drug Pharmacy Program.) We may request updated treatment plans as your treatment progresses.Ĭlaims for prescription drugs and supplies that are not received from the Retail Pharmacy Program must include receipts that show the prescription number, name of drug or supply, prescribing provider’s name, date, and charge. Claims for dental care to repair accidental injury to sound natural teeth should include documentation of the condition of your teeth before the accidental injury, documentation of the injury from your provider(s), and a treatment plan for your dental care.If your claim is for the rental or purchase of durable medical equipment, home nursing care, or physical, occupational, speech, or cognitive rehabilitation therapy, you must provide a written statement from the provider specifying the medical necessity for the service or supply and the length of time needed.

Bills for home nursing care must show that the nurse is a registered or licensed practical nurse.If another health plan is your primary payor, you must send a copy of the explanation of benefits (EOB) form you received from your primary payor (such as the Medicare Summary Notice (MSN)) with your claim.Note: Canceled checks, cash register receipts, balance due statements, or bills you prepare yourself are not acceptable substitutes for itemized bills. Dates that services or supplies were furnished.Name and address of person or company providing the service or supply.Patient’s name, date of birth, address, phone number, and relationship to enrollee.Bills and receipts should be itemized and show: For long or continuing inpatient stays, or other long-term care, you should submit claims at least every 30 days. Use a separate claim form for each family member. When you must file a claim – such as when another group health plan is primary – submit it on the CMS-1500 or a claim form that includes the information shown below. Your facility will file on the UB-04 form. Your provider must file on the CMS-1500, Health Insurance Claim Form. Just present your ID card when you receive services. To obtain claim forms or other claims filing advice, or answers to your questions about our benefits, contact us at the customer service phone number on the back of your ID card, or at our website at In most cases, physicians and facilities file claims for you. See Section 3 for information on pre-service claims procedures (services, drugs, or supplies requiring precertification or prior approval), including urgent care claims procedures.

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 Section primarily deals with post-service claims (claims for services, drugs, or supplies you have already received). 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.

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Il bcbs timely filing limt