AdministrativeCommercialJuly 1, 2024

Timely receipt of other carrier EOB or rejection helps avoid timely filing denials

When working with another carrier, submit documentation from the other carrier when you send the claim to Anthem to help avoid the claim from denying for timely filing. You can submit the documentation and the claim through Availity Essentials using the Claims and Payments application.

If we are the secondary payer, we will need to receive an Explanation of Benefits (EOB) along with the claim submission to determine our payment amount. To avoid a timely filing denial, the documentation must demonstrate that submission to the other insurer was within Anthem’s timely filing limit and must reflect that it was received within the timely filing limit starting from the date of the remittance advice or Explanation of Payments.

If you submit to the other carrier first and receive a rejection, submit the denial letter from the other insurance carrier along with the claim. To avoid a timely filing denial, the denial letter must be dated and printed on letterhead, and the claim and documentation must be submitted to Anthem within the timely filing limit starting from the date of the denial letter.

When a claim is submitted to us as the primary payer, and we are the secondary payer, our claims system will deny the claim because we don’t have the EOB. This can delay your receiving payment and can also cause you to miss the timely filing guideline.

Through our efforts, we are committed to reducing administrative burden and ensuring timely payments because we value you, our care provider partners.

Resource

Coordination of benefits — how to avoid timely filing denial

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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ATTACHMENTS: Coordination of benefits — how to avoid timely filing denials (pdf - 0.32mb)

PUBLICATIONS: July 2024 Provider Newsletter