![]() Some wish to hold claims for multiple days for various and legitimate reasons. Now, we realize not all groups want to abide by this 48-hour time recommendation. Every day of delay in the completion and delivery of the record increases the possibility of not getting paid. Medical groups should have a systematic process in place to get the medical record from the provider to our billing office within 48 hours, where practicable. Those days of lackadaisical nonchalance are coming to an end. ![]() He literally drove around with stacks of anesthesia records on the back floorboard of his car, turning them over to the billing staff only when so moved. I will never forget hearing years ago about a particular anesthesiologist who routinely waited several weeks to submit his documentation. It goes without saying that providers will need to tighten up on their timely delivery of medical records, reports and progress notes to our billing office. Ensure Expeditious Delivery of Your Records.To lessen the likelihood of denials due to timely filing errors, we recommend the following strategies: What this effectively means is that more Anthem claims could be denied- unless certain measures are taken by providers in conjunction with our billing staff. In fact, that time has been cut by half for in-network services, and we now have nine fewer months to submit out-of-network claims. The upshot of all this is that we now have far less time to process these Anthem claims. So, Anthem is not alone in the 90-day deadline for claim submission from the date of service. Humana – 180 days 90 days for ancillary providers.These Anthem notifications typically include the additional instruction that if the Anthem plan acts as the secondary payer, the 90-day period will not begin until the provider receives notification of the primary payer’s responsibility.Īs a means of comparison and unless otherwise stipulated by state law or contract provisions, the following commercial payers hold to the following filing deadlines for most in-network claims, in most states: This means claims submitted on or after Octowill be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service. ![]() By and large, the typical notification found on many of Anthem’s subsidiary sites contains the following or similar language: Effective for all claims received by Anthem on or after October 1, 2019, all impacted contracts will require the submission of all professional claims within ninety (90) days of the date of service. In California, only Anthem Blue Cross plans are at issue, as Blue Shield operates independently. Notifications from some states, such as New Hampshire and New York, specified the change was only applicable to Medicare Advantage plans. However, this may have been an oversight, as one Anthem representative has informed us that the new 90-day deadline is applicable to all Anthem states. This notification was noticeably absent from Anthem’s Virginia website at the time of this writing. States that have issued advisories of this change include California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio and Wisconsin. Notifications have been issued by most of Anthem’s state subsidiaries to the effect that these previous filing deadlines have been changed to 90 days for all professional claims. What was once a 180-day allowance for in-network claims (365 days for non-participating claims) has now been considerably shortened. In recent days, one health insurance company has added one more time pressure to our increasingly hectic schedules.Īnthem Blue Cross Blue Shield Healthcare Solutions (Anthem) has instituted a change in its timely filing deadline. Yes, there is little doubt that the underlying pressures that many Americans feel in this fast-paced society are due, in large measure, to the reality and inevitability of the fourth dimension-time. Despite all attempts to tame it and control it, time tends to have the last word. Wells published a novella about an inventor who built a machine to master time but, by the end of the story, time had gotten the better of the inventor. Who among us has not experienced the stress of having to meet toxic timetables and dreaded deadlines? It’s just part of our daily reality. Though, at times, we would like nothing more than to slow things down, the passage of time propels us into the maelstrom and compels us to take action. The clock is ticking and the days are flying. This article provides the details as well as the strategies anesthesia groups can leverage to avoid costly delays in the claims-submission process. A major payer has severely limited its timely filing deadlines.
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