Ensure timely filing and appeal submissions for claims

Summary:

• Timely filing rules: Submit original claims within 365 days of the date of service. Corrected claims must be received within 12 months of Explanation of Payment (EOP).
• Appeal deadlines: Claim payment reconsideration must be filed within 12 months of the EOP. Claim payment appeals must be filed within 15 months of service or 180 days from the reconsideration decision. Filing options: Use provider manual guidelines for disputes; submit via Provider Services, Availity Essentials, or in writing.

This alert serves as a reminder of the rules surrounding timely filing requirements.

Please be mindful that the timely filing period is 365 days from the date of service.

Additionally, corrected claims must be received within 12 months of the original EOP date.

Claim payment reconsideration is the first step in the provider payment dispute process and must be received within 12 months from the issuance of the EOP. Claim payment appeal is the second level of the provider dispute process. Claims payment appeals must be filed within 15 months of service or 180 days from the reconsideration decision. HealthKeepers, Inc. cannot process a claim payment appeal without a reconsideration on file.

We urge providers to correctly observe these timelines to ensure the smooth processing of claims and appeals.

Our provider manual includes detailed procedures for filing a claim payment dispute, including several alternatives for submission such as verbally through Provider Services, online via the Availity Essentials Payment Appeal Tool, or in writing to the Payment Appeals Unit for HealthKeepers, Inc.

For more details on these options and required documentation, kindly review the provider manual or visit anthem.com > Resources > Forms to access the Claim Information/Adjustment Request 151 Form for Medicaid Claims.

Thank you for your attention to this matter. Your adherence to these guidelines is both appreciated and required.

If you have any questions about this communication, call Anthem HealthKeepers Plus Provider Services at 800-901-0020.

We are committed to a future of shared success.