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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• 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:
• NYS OMH ACT services- new rate codes for 2027
  Are you a NY provider that bills for Youth or Adult ACT services? Then this blog post is for you! What is changing? As per NYS OMH- for any DOS 1/1/27 and thereafter the rate codes for youth and adult ACT services will change. For MCOs- the following plan types are affected by this change:… Read more: NYS OMH ACT services- new rate codes for 2027
• Aetna trauma response reimbursement
  The following update applies to Aetna Commercial and Medicare plans. What is changing? In order to get reimbursement for trauma response services Aetna will require an accompanying HCPCS code with the cooresponding Rev codes A qualifying ambulance transport service on the same DOS Rev codes affected: 0681: Trauma Response, Level I0682: Trauma Response, Level II0683:… Read more: Aetna trauma response reimbursement