#Blue cross timely filing manual#
#Blue cross timely filing full#
#Blue cross timely filing professional#

Home IV drugs: NDC number and quantity is missing.

Anesthesia time is billed in units to represent minutes and additional base units for the code.

Anesthesia: The hours/minutes for anesthesia claims are not included.

The claim rejects if records are not attached that support the change.

Rebilling: Records are missing when rebilling with a different diagnosis or other change.

Information doesn't match: Physician/provider information doesn't exactly match what is in our payment system.

Here are common reasons why claims suspend or reject: Information from Anthem Blue Cross Blue Shield and HMO Colorado.Be sure to submit a paper CMS-1500 claim form or electronic 837P claim form that is complete and accurately filled out.

#Blue cross timely filing manual#

From the Provider Home page, under the Communications and Updates heading, select the Provider Manual link, and then select the link titled Provider and Facility Manual: February 1, 2019. Select Find Resources for Your State, and pick Colorado. Select Providers, and Providers Overview. Pathology codes are excluded from this adjustment.Īnthem’s Provider Manual is available online. Effective October 1, 2019, Anthem will adjust the reimbursement for lab services performed in the Provider’s office from 100% of the Medicare year Anthem has implemented to 60% of the Medicare year Anthem has implemented. The Provider Manual is available online see navigation instructions below.)Īnthem continues to reimburse for laboratory services done in the Provider’s office, and no changes are being made to the services allowed in office.

#Blue cross timely filing full#

(Please reference the Laboratory Services section of our Provider Manual for the full list of procedures that can be performed in the Provider’s office.

All lab work, including Pap tests and routine outpatient pathology, must be sent to LabCorp, with the exception of the procedures that can be performed in the Provider’s office.

Laboratory Services done in the Provider’s OfficeĪnthem is contracted with Laboratory Corporation of America® (“LabCorp”). Effective October 1, 2019, Anthem will adjust the reimbursement for consult codes to match the same contractual allowed amount as your contract defines for Evaluation and Management (E/M) codes. Payment methodology change / reimbursement adjustment – Consult codes and Laboratory Services done in the Provider’s OfficeĪnthem Blue Cross and Blue Shield and our subsidiary company, HMO Colorado (Anthem) would like to make you aware of changes to our payment methodology / reimbursement adjustment that will be effective for dates of service on or after October 1, 2019.Īnthem continues to reimburse for consult codes (99241 – 99245). *If Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility. NOTE: ALL CLAIMS WITH DATES OF SERVICE PRIOR TO OCTOTHAT WILL BE MORE THAN 90 DAYS FROM THE DATE OF SERVICE ON OCTOBER 1 SHOULD BE SUBMITTED PRIOR TO OCTOTO AVOID A TIMELY FILING DENIAL. the claim would deny if submitted on or after October 4, 2019.) This means all claims submitted on or after October 1, 2019, will 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.*įor instance, for a claim with a date of service of July 5, 2019, the claim would be untimely if submitted more than 90 days after that date of service (i.e.

#Blue cross timely filing professional#

In an effort to simplify processes, improve efficiencies, and better support coordination of care, we are changing all professional agreements to adopt a common time frame for you to submit claims.Įffective for all claims submitted to plan on or after October 1, 2019, your Anthem Provider Agreement(s) will be amended to require the submission of all professional claims for commercial and Medicare Advantage plans within ninety (90) days of the date of service. Timely receipt of medical claims for your patients, our members, helps our chronic condition care management programs work most effectively, and also plays a crucial role in our ability to share information to help you coordinate patient care. Changes to timely filing requirements for commercial and Medicare Advantage plans for all claims submitted to plan on or after October 1, 2019Īnthem Blue Cross and Blue Shield and HMO Colorado (hereinafter collectively referred to as Anthem) continues to look for ways to improve our processes and align with industry standards.