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.

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• Healthfirst Genertic testing- updated reimbursement policies
  Did you know that Healthfirst has partnered with an outside company-Concert Genetics- to update their reimbursement policies for both molecular and genetic testing? If you are a NY provider and accepting Healthfirst members then this blog post is for you! For any DOS on May 1,2026 and there after the Healthfist will aligb with the… Read more: Healthfirst Genertic testing- updated reimbursement policies
• UHC MO community provider appt availability
  If you are a provider located in Missouri and accepts UHC Community Health members then make sure your office is compliant and adheres to the following appointment availability standards. Allowable patient wait times (in office)- 1 hour from the scheduled appt time. Providers also have to have after hour coverage- acceptable are the following: Not… Read more: UHC MO community provider appt availability
• Healthfirst Lab Prior auth updated list
  If you are a labolatory that accepts Healthfirst members, then this blog post is for you! For any DOS 4/1/26 and thereafter the following codes will require a prior auth: Find this type of content useful? Follow my blog for more!
• Aetna: Pre-auth requirenments changes
  The following changes/updates apply to Medicare and Commercial plan types only. Medicare and Medicaid DME: for any DOS beginning 7/1/25 and thereafter the following codes will no longer require prior auth: Medicare and Commercial Dental pre-auth changes: the following codes will no longer require an auth- For Medicare only- no longer requires prior auth: Find… Read more: Aetna: Pre-auth requirenments changes
• Fideliscare: E/M reimbursement policy
  If you are a NY provider that accepts Fideliscare members then this blog post is for you! E/M modifiers: What do you need to know! Reimbursement: Find this information useful? Follow my blog for more!