Changes to timely filing requirements for Commercial plans for all claims submitted to plan on or after October 1, 2019

Empire BlueCross BlueShield (“Empire”) continues to look for ways to improve our processes and align with industry standards. Timely receipt of medical claims for your patients —our members— helps our chronic condition care management programs work most effectively and also plays a crucial role in our ability to share information to help you coordinate patient care. In an effort to simplify processes, improve efficiencies, and better support coordination of care, we are changing all professional agreements to adopt a common time frame for you to submit claims.

 

Effective for all claims submitted on or after October 1, 2019, your Empire Provider Agreement was amended to require the submission of all professional claims within 120 days of the date of service. This means all claims submitted on or after October 1, 2019, will be subject to a 120-day timely filing requirement, and Empire will refuse payment if submitted more than ninety 120 days after the date of service¹.

 

^[1] If Empire is the secondary payer, the 90-day period will not begin until Provider receives notification of primary payer’s responsibility.