Keeping up current on any claim timely filing updates is crucial for your business!

Claims that are denied for timely filing can be rarely appealed and get paid. (Certain situations like COB/Natural disaster)

So, I always pay a close attention to any timely filling changes that are reported by the healthcare payers/plans.

Below please note the changes that took place for Self Funded (ASO) type of plans.

Find this type of information useful? Please follow my blog for more healthcare related information.

• NYS RX: adult vaccine reimbursement and Billing change
  There is an update to how the NYS Medicaid Pharmacy program will reimburse the pharmacies for vaccines that are billed by the NDC#. This change does not apply to the vaccines administered under Vaccines for children program. Proper Billing: for any vaccines that are billed by the NDC One claim should be submitted with a… Read more: NYS RX: adult vaccine reimbursement and Billing change
• Healthfirst: psychiatric evaluation reimbursement update
  For any DOS effective 10/1/25 and thereafter Healthfirst will reimburse psychiatric evaluation services that is with the accordance to the CMS LCD #L35101 and the Local Coverage Article (LCA) A57130 for Jurisdictions H & L. To access the Local LCD please click here. To access the Local LCA- for codes info, please click here. The… Read more: Healthfirst: psychiatric evaluation reimbursement update
• Ambetter from Fidelis Care updated priorauthorization info
  If you are a provider that accepts members with Ambetter from Fidelis Care members. Starting 4/1/26 there are prior authorization changes to the following codes/procedures. Please make sure you use the updated guidelines. Find this type of content useful? Follow my blog for more payer updates.
• UHC New Mexico: new required information on claims
  This post applies to all providers that bill fee-for -service and  Turquoise Care MCOs. Please note that Turquoise Care recently updated its taxonomy crosswalk. Please log into New Mexico Medicaid portal to identify the proper Taxonomy code. What is required? What will happen if the info is missing or incorrect? 1.UHC will reject claims if… Read more: UHC New Mexico: new required information on claims
• Fidelis Medicaid Plans: prior auth updates
  If you are a NY provider and accepting Fidelis Medicaid Members in your practice, then this blog post is for you. The following changes will apply to certain procedures/codes starting for any DOS 4/1/26 and thereafter. Find this information useful? Follow my blog for more payer updates.