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.

• Highmark BCBS: update-molecular lab prior auth process
  If you are a laboratory provider that accepts Highmark BCBS insurance in your office/facility, then this blog post is for you! A new vendor to offer prior authorization review: HealthHelp. What is changing for NYS providers? NYS – most of the molecular/genetic laboratory procedures do not require an authorization. Starting for any DOS 10/1/26 and… Read more: Highmark BCBS: update-molecular lab prior auth process
• Cigna: BH Appeal update
  If you are a BH provider that accepts Cigna insurance in your practice or facility, then this blog post is for you! What has changed? The process- to make it easier- providers should contact Evernorth directly instead of Cigna. How to request an appeal? Providers can fill out a form – Behavioral Appeals Cover Sheet… Read more: Cigna: BH Appeal update
• MA medicaid weight loss drug coverage update
  Please note that for any DOS on or after 7/3/26, MA Medicaid will no longer cover the following drugs for weight loss and obesity indication. The updated coverage will apply MA UHC Community Health Plan. What is not changing? The drugs are still covered for indications that are covered by CMS: type 2 diabetes, obstructive… Read more: MA medicaid weight loss drug coverage update
• Aetna: usage of modifier CT and reimbursement
  If you are a provider that accepts Aetna Commercial and Medicare Plans? Then this blog post is for you! For any DOS 9/1/2026 and thereafter Aetna, once the provider bills the modifier CT, will apply a 15% payment reduction will be applied to certain radiology services. Definition: CT modifier is used to represent that CT… Read more: Aetna: usage of modifier CT and reimbursement
• NYS Medicaid: Article-29 VFCA medical billing changes
  Are you an Article -29 VFCA facility or a provider that performs the services at such facility? Then the following blog post is for you! As of Nov 20, 2025 NYS DOH updated the Article-29 VFCA billing and coding guide. Notable Changes: Where to find all of the info? Find this information useful? Follow my… Read more: NYS Medicaid: Article-29 VFCA medical billing changes