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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• Aetna: Onservation Payment Policy
  The following policy applies to Aetna Commercial and Medicare plan types. Reminder: In order for hospitals to receive reimbursement for observation services there is a min number of units that has to met: 8 hours or more. Code affected: G0378-hospital observation service, per hour on facility outpatient claims. If the services do not meet the… Read more: Aetna: Onservation Payment Policy
• UHC: The Michigan Collaborative for Type 2 Diabetes (MCT2D)- changes
  Are you a provider in Michigan that provide  glucose monitors (CGM) for UHC patients that have Type 2 Diabetes? Then this blog post ia for you! What you should know? The Michigan Collaborative for Type 2 Diabetes (MCT2D)- was a pilot program that will end on 1/1/27 Under this program the prior authorization process was bypassed… Read more: UHC: The Michigan Collaborative for Type 2 Diabetes (MCT2D)- changes
• NYS Medicaid: Billing for denture services (FQHCs) patients with third party insurance
  If you are a NY FQHC w/(PPS) payment that provides denture services (not DME itself) for the Medicaid members with a third party insurance? Then the following blog post is for you! Medical Billing: coordination of benefits In order to ensure proper coordination of benefits the FQHCs should bill the third-party insurance and/or commercial insurance… Read more: NYS Medicaid: Billing for denture services (FQHCs) patients with third party insurance
• Fidelis: corrected claim submissions
  Are you a NY provider that submitted a corrected claim and received a code 6U, then this blog post is for you! Submitting a corrected claim is something that providers are familiar with. However, let’s not forget that the process may vary between payers, including the timely filling frame. In the following blog post we… Read more: Fidelis: corrected claim submissions
• BCBS Highmark NY:
  Are you a NY provider that after submitting a claim through Availity received following response codes: A7:21, A7:583, A7:476? Then this blog post is for you! What is changing? As per Highmark- any professional claims for DOS 7/17/26 and thereafter will have pre-adjudication validation edit for proper number of billed charges and units for services… Read more: BCBS Highmark NY: