Outcome– The rules to suspend the timeline for appealing a decision do not apply because the appeal should have been filed by Nov. The claimant files an appeal on March 24, 2020. Situation – The adverse decision is received by the claimant on June 1, 2019. Until further notice, we will accept as timely all valid appeals of adverse benefit notifications dated on or after Sept. In compliance with the guidelines, the period from March 1, 2020, to 60 days after the announced end of the National Emergency will not count towards the deadline to submit an appeal. The 180-day timeline for appealing an adverse benefit determination on a claim has been suspended as well. Outcome – If the National Emergency were over on June 1, 2020, the 180-day timeline to file this claim would start 60 days later, on July 31. Situation (assume 180-day timely filing rule) – The date of service was March 1, 2020.

On July 31, one day remains to file the claim. 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. Outcome – The rules to suspend timely filing do not apply. Situation (assume 180-day timely filing rule) – The time for a claim to fulfill the timely filing 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.

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 an adverse benefit determination.

The date within which individuals may file a claim.

What does this mean? 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: We will follow these guidelines.Īpplies to: This is for members of all fully insured and self-funded groups that are regulated by the Employee Retirement Income Security Act. 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.Federal Agencies Extend Timely Filing and Appeals Deadlines June 24, 2020Īs a result of the National Emergency declared on March 1, 2020, the Employee Benefits Security Administration, Department of Labor (DOL), Internal Revenue Service and the Department of the Treasury extended certain timeframes to ease the burden of maintaining benefits and compliance with notice obligations. 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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