Tag: #timelyfilling

Posted in EmblemHealth NY, NY Providers, Payer Updates

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

Posted on 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.

Via Emblem Health

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  • Tufts Health One Care: New Plan name and ID cards
    Does your provider accept Tufts Health One Care insurance? Then this blog post is for you- don’t leave money on the table and waste precious administrative time! As of Jan 1,2026- Tufts Health One Care became Tufts D-SNP – with such change members will receive new ID cards and member numbers. New ID cards: Authorizations… Read more: Tufts Health One Care: New Plan name and ID cards
  • Fidelis MMC: healthy nutrition benefit
    Fidelis (NY) has partnered up with Foodsmart vendor to offer the Managed Medicaid Members nutrition services- “fully covered by the plan”. The services include a personalized telenutrition from registered nutritionist. Foodsmart services include: For more information, providers should contact: Paula West, Director of Provider Relations, at Paula.West@foodsmart.com. Ready to refer a member? Find this information… Read more: Fidelis MMC: healthy nutrition benefit
  • UHC Medicaid: Idaho: diabetic DME coverage change-benefit
    Starting for DOS 4/1/26 and thereafter the following codes will be covered through the patient pharmacy benefit and no longer will be covered under patient medical benefit. For DOS 1/1/26 through 3/1/26- providers can still bill either through medical benefit or pharmacy benefit. Find this type of content useful? Follow my blog!
  • Anthem BCBS: 32BJ fund new TPA and cards
    As the new year starts so do the change of theember ID changes and or group numbers. Is your provider office aware of these changes? Please note that for any 32BJ members there is a new TPA, group#, member ID, and cards. Please note the new ID: Effective Jan 1,2026- new members ID prefix BJVBJ.… Read more: Anthem BCBS: 32BJ fund new TPA and cards
  • Are you leaving revenue on the table?
    Aetna update! Is your practice compliant? Are you appending proper modifiers to radiology, diagnostic services and surgery services- when billed with the following ICD-10 codes: Z53.01, Z53.09, Z53.1, Z53.20, Z53.21, Z53.29, Z53.8, Z53.9? As per Aetna- if the following modifiers are not billed on the claims for the above services with above named ICD-10 codes-… Read more: Are you leaving revenue on the table?
Posted in #aetna, Training, Updates

Aetna: Non participating provider New Timely filling frame

Posted on 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.

Picture via Performance Adjusting

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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Posted in Insurance, Training, Updates

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

Posted on 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)