Anthem is Changing their Timely Filing Requirements for All Plans, Including Medicare Advantage

July 26th, 2019 - Namas
Categories:   Medicare   Medicare Advantage   Claims  
0 Votes - Sign in to vote or comment.

Anthem has been very busy sending out notices stating that, beginning October 1, 2019, all timely filing deadlines for claims will be 90 days. We've seen this letter, or something very similar, sent to doctors and other healthcare providers from California to Kentucky.

In their notice, Anthem states:

"Effective for all commercial and Medicare Advantage Professional Claims submitted to the plan on or after Oct. 1, 2019, your Anthem Blue Cross and Blue Shield (Anthem) Provider Agreement(s) will be amended to require the submission of all commercial and Medicare Advantage professional claims within ninety (90) days of the date of service. This means all claims submitted on or after October 1, 2019 will be subject to a ninety (90) day timely filing requirement."
 
They further state:

"If you object to the enclosed amendment, you must provide us with written notice of your appeal within 30 days of receipt of this letter. If, after 30 days, we are unable to reach an agreement, your contract will terminate on or before October 1, 2019."

If you do not accept these terms, you can "object," according to Anthem's wording, but it's pretty clear that your contract with Anthem will terminate on October 1, 2019.
Click Here to view the letter we received from an AMBA member's Kentucky doctor.
Medicare allows 12 months on timely, right?

If you ask Medicare Advantage payers whether they follow Medicare rules and regulations, they will tell you that they do. But in fact, this is a classic example of Medicare Advantage payers NOT following Medicare regulations. We all already know this, but here is Medicare's rule regarding timely filing:
 
"Claims must be filed to the appropriate Medicare claims processing contractor no later than 12 months, or 1 calendar year, after the date the services were furnished."
Medicare Advantage Plans do not have to follow the same rules that Medicare Fee-for-Service plans must. Here are the regulations for Medicare Advantage Plans.
 
How Anthem and others (UHC, Aetna) get around the 12-month timely filing limitation
It's very simple - these payers have tied their timely filing policy to the provider's contract. If you are NOT contracted with Anthem, then you may have other remedies to rely on, such as your state law (Florida requires at least 6 months, Virginia requires at least 12 months). You should ensure you are benefitting from these longer deadlines if you are not contracted. It's only fair when most Medicare Advantage Plans are already using contracts to limit those providers to 90-day timely filing deadlines.
Here's a tip if you have passed the timely filing deadline: a Medicare Advantage patient can absolutely file a grievance with Anthem or any other Medicare Advantage payer and may be able to get the full 12 months allowed under Medicare regulations.
And here's another tip: an ERISA appeal may provide 12 months on plans that are subject to ERISA law (employer group plans that are not a church plan and not a Government plan).
Watch for more notifications from Anthem - there is a new prior authorization letter circulating and we will be talking about this as well as their new modifier -25 edits in the next few days.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

CMS and HHS Tighten Enrollment Rules and Increase Penalties
October 1st, 2019 - Wyn Staheli, Director of Research
This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019. There have been known problems ...
Federal Workers Compensation Information
October 1st, 2019 - Wyn Staheli, Director of Research
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...
E-Health is a Big Deal in 2020
September 16th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
The new 2020 CPT codes are on the way! We are going to see 248 new codes, 71 deletions, and 75 revisions. Health monitoring and e-visits are getting attention; 6 new codes play a vital part in patients taking a part in their care from their own home. New patient-initiated ...
Chiropractic 2020 Codes Changes Are Here
September 9th, 2019 - Wyn Staheli, Director of Research
There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?
Q/A: Is the Functional Rating Index by Evidence-Based Chiropractic Valid?
September 9th, 2019 - Wyn Staheli, Director of Research
Question Is the Functional Rating Index, from the Institute of Evidence-Based Chiropractic, valid and acceptable? Or do we have to use Oswestry and NDI? Answer You can use any outcome assessment questionnaire that has been normalized and vetted for the target population and can be scored so you can compare the results from ...
List of Cranial Nerves
September 3rd, 2019 - Find-A-Code
Cranial nerves are involved with some of our senses such as vision, hearing and taste, others control certain muscles in the head and neck. There are twelve pairs of cranial nerves that lead from the brain to the head, neck and trunk. Below is a list of Cranial Nerves and ...
So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?
August 21st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...



About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association