#timelyfilling – KR2 Medical Billing

EmblemHealth NY, NY Providers, Payer Updates

Emblem Health: claims timely filling update- Self Funded Plans (ASO)

Posted on October 7, 2024 by KR2Medical Billing

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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UHC to remove prior auth for some radiology and cardiology tests.
Starting Jan 1, 2026 certain nuclear imaging tests, OBGYN ultrasounds, and certain cardiology tests will no longer require a prior authorization for some of the following plan types: 1.UnitedHealthcare Insurance Company2.UnitedHealthcare Mid-Atlantic, inc. 3.UnitedHealthcare Plan of the River Valley, Inc. and 4.UnitedHealthcare Insurance Company of the River Valley5.Oxford Health Insurance, Inc.United Healthcare Level Funded (formerly All… Read more: UHC to remove prior auth for some radiology and cardiology tests.
Anthem BCBS NY: New PET tracer UM policy
The following information will apply to any DOS on 12/1/25 and thereafter. Starting 12/1/25 the PET tracer will require an auth in addition to PET services. Please submit both PET and radiotracer codes- for prior authorization. The UM criteria for PET will not be affected. However both codes will be either approved or denied. Please… Read more: Anthem BCBS NY: New PET tracer UM policy
PrEP proper billing and coding
Proper Medical coding and billing is important to the financial health of your practice! Medication codes: Administration code Please avoid using the regular 96372 administration code. Instead use the following administration code: G0012 This code is used when the provider physically administers the PrEP medication. Supply Code For the oral PrEP pharmacies should bill: Q0251… Read more: PrEP proper billing and coding
MVP to end its relationship with naviHealth, Inc
Currently naviHealth, Inc handles Utilization and Case/Care Management for post-acute services—including Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), and Home Health—for MVP Medicare Advantage, DualAccess, and DualAccess Complete Members. However, MVP and naviHealth, Inc will end their contract as of Dec 31st 2025. Starting on Jan 1,2025 MVP will process these requests in house.… Read more: MVP to end its relationship with naviHealth, Inc
MVP postpartum program incentive payments: NY providers!
Are you any of these following providers in NY? OB/GYN Family Medicine Certified Nurse Mid-wives Nurse Practitioner – Family Health Then this blog post is for you! NY DOH established an additional payment (to global OBGYN bundled payment) for providers that complete a person-centered postpartum visit— including a depression screening—within 12 weeks of delivery, as… Read more: MVP postpartum program incentive payments: NY providers!

#aetna, Training, Updates

Aetna: Non participating provider New Timely filling frame

Posted on October 5, 2021 by KR2Medical Billing

Recently, while I was preparing for my Denials Management Made Easy Webinar (Physician Services), coming soon, I researched the 8 most common denial types.

One of those common denials is timely filing.

Timely filling frame is the time given to providers to send their clean claims to the insurance payer. Each insurance payer has different timely filling time frames. These time frames also differ for In and Out of network providers.

Training your staff on keeping current with timely filling changes will help you avoid unnecessary denials and ensure that claims are submitted on time and paid.

In this article, as you see by the title of it, we will look at the timely filling requirements change for AETNA Out of network providers.

As per Aetna, for all claims submitted on or after DOS 01/01/2022 the new timely filling will be 12 months. Down from 27 months.

Aetna is doing this to match Centers for Medicare & Medicaid Services (CMS) standards. The change will apply to medical procedures.

Dental Out of network providers will continue to have 27 months timely filling frame for their claims.

According to Aetna the denials will start showing up in 2023 and all policy exceptions to timely filing today will apply after this change and will be supported as they are today.

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Insurance, Training, Updates

Empire BCBS of New York (commercial plans) Timely filling changes- 2020

Posted on February 11, 2020February 17, 2020 by KR2Medical Billing

Effective April 1st 2020 all claims (commercial plans) will be subject to 120 days timely filling requirement.

Things to consider:

1. This applies towards the dates of service rendered before 4/1/2020 AND for dates of service on or after 4/1/2020.

2. This applies to any claim submitted to Empire on 4/1/2020.

Example if patient was seen on 12/30/2019 and your office submits the claim on 4/1/2020 then claim will be denied for timely filling.

In network providers should receive an amendment to the provider agreement (effective date 4/1/2020)

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