Learn more about billing and how to submit claims to us for payment, including claims for BlueCross and BlueShield Federal Employee Program (BCBS FEP) members. If MAXIMUS disagrees with our decision, we authorize or pay for the requested services within the timeframe outlined by MAXIMUS. | September 16, 2022. Regence BCBS of Oregon is an independent licensee of. You will receive written notification of the claim . This means that the doctor's office has 90 days from February 20th to submit the patient's insurance claim after the patient's visit. We recommend you consult your provider when interpreting the detailed prior authorization list. When you provide covered services to a Blue Shield member, you must submit your claims to Blue Shield within 12 months of the date of service(s) unless otherwise stated by contract. . Claims Submission. Anthem BCBS of Ohio, Kentucky, Indiana and Wisconsin timely filing limit for filing an initial claims: 90 Days form the date service provided. In addition to the instructions in this section and other sections of the manual, participating providers (Provider) shall adhere to the following policies with respect to filing claims for Covered Services to BCBS members: 1. If an Out-of-Network Provider charges more than your plan allows, that Provider may bill you directly for the additional amount. Assistance Outside of Providence Health Plan. An EOB explains how Providence processed your Claim, and will assist you in paying the appropriate member responsibility to your Provider. An EOB is not a bill. We will provide a written response within the time frames specified in your Individual Plan Contract. Regence BlueShield. Give your employees health care that cares for their mind, body, and spirit. If you fail to obtain a Prior Authorization when it is required, any claims for the services that require Prior Authorization may be denied. Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing, Premera BCBS timely filing limit - Alaska, Premera BCBS of Alaska timely filing limit for filing an initial claims: 365 Days from the DOS, Blue Cross Blue Shield of Arizona Advantage timely filing limit, BCBS of Arizona Advantage timely filing limit for filing an initial claims: 1 year from DOS, Anthem Blue Cross timely filing limit (Commercial and Medicare Advantage plan) Eff: October 1 2019, Anthem Blue Cross timely filing limit for Filing an Initial Claims: 90 Days from the DOS, Highmark BCBS timely filing limit - Delaware, Highmark Blue Cross Blue Shield of Delaware timely filing limit for filing initial claims: 120 Days from the DOS, Blue Cross Blue Shield timely filing limit - Mississippi, Blue Cross Blue Shield of Mississippi timely filing limit for initial claim submission: December 31 of the calendar year following the year in which the service was rendered, Highmark BCBS timely filing limit - Pennsylvania and West Virginia, Highmark Blue Cross Blue Shield of Pennsylvania and West Virginia timely filing limit for filing an initial claims: 365 Days from the Date service provided, Carefirst Blue Cross Blue Shield timely filing limit - District of Columbia, Carefirst BCBS of District of Columbia limit for filing an initial claim: 365 days from the DOS, Florida Blue timely filing limit - Florida, Florida Blue timely filing limit for filing an initial claim: 180 days from the DOS, Blue Cross Blue Shield of Hawaii timely filing limit for initial claim submission: End of the calendar year following the year in which you received care, Blue Cross Blue Shield timely filing limit - Louisiana, Blue Cross timely filing limit for filing an initial claims: 15 months from the DOS, Anthem Blue Cross Blue Shield timely filing limit - Ohio, Kentucky, Indiana and Wisconsin, Anthem BCBS of Ohio, Kentucky, Indiana and Wisconsin timely filing limit for filing an initial claims: 90 Days form the date service provided, Wellmark Blue Cross Blue Shield timely filing limit - Iowa and South Dakota, Wellmark BCBS of Iowa and South Dakota timely filing limit for filing an initial claims: 180 Days from the Date of service, Blue Cross Blue Shield timely filing limit - Alabama, BCBS of Alabama timely filing limit for filing an claims: 365 days from the date service provided, Blue Cross Blue Shield of Arkansas timely filing limit: 180 days from the date of service, Blue Cross of Idaho timely filing limit for filing an claims: 180 Days from the DOS, Blue Cross Blue shield of Illinois timely filing limit for filing an claims: End of the calendar year following the year the service was rendered, Blue Cross Blue shield of Kansas timely filing limit for filing an claims: 15 months from the Date of service, Blue Cross timely filing limit to submit an initial claims - Massachusetts, HMO, PPO, Medicare Advantage Plans: 90 Days from the DOS, Blue Cross Complete timely filing limit - Michigan, Blue Cross Complete timely filing limit for filing an initial claims: 12 months from the DOS or Discharge date, Blue Cross Blue Shield Timely filing limit - Minnesota, BCBS of Minnesota Timely filing limit for filing an initial claim: 120 days from the DOS, Blue Cross Blue Shield of Montana timely filing limit for filing an claim: 120 Days from DOS, Horizon BCBS timely filing limit - New Jersey, Horizon Blue Cross Blue shield of New Jersey timely filing limit for filing an initial claims: 180 Days from the date of service, Blue Cross Blue Shield of New Mexico timely filing limit for filing an claims: 180 Days from the date of service, Blue Cross Blue Shield of Western New York timely filing limit for filing an claims: 120 Days from the Date of service, Blue Cross Blue Shield timely filing limit - North Carolina, BCBS of North Carolina timely filing limit for filing an claims: December 31 of the calendar year following the year the service was rendered, Blue Cross Blue Shield timely filing limit - Oklahoma, BCBS of Oklahoma timely filing limit for filing an initial claims: 180 days from the Date of Service, Blue Cross Blue Shield of Nebraska timely filing limit for filing an initial claims: It depends on the plan, please check with insurance, Filing an initial claims: 12 months from the date of service, Independence Blue Cross timely filing limit, Filing an initial claims: 120 Days from the date of service, Blue Cross Blue Shield timely filing limit - Rhode Island, BCBS of Rhode Island timely filing limit for filing an claims: 180 Days from the date of service, Blue Cross Blue shield of Tennessee timely filing limit for filing an claims: 120 Days from the date of service, Blue Cross Blue Shield timely filing limit - Vermont, Blue Cross Blue Shield of Wyoming timely filing limit for filing an initial claims: 12 months from the date of service. If you are seeing a non-participating provider, you should contact that providers office and arrange for the necessary records to be forwarded to us for review. Offer a medical therapeutic value at least equal to the Covered Service that would otherwise be performed or given. A letter will be sent to you and your provider detailing the reason for the denial and explaining your appeal rights if you feel the denial was issued in error. **If you, or your prescribing physician, believe that waiting for a standard decision (which will be provided within 72 hours) could seriously harm your life, health or ability to regain maximum function, you can ask for an expedited decision. If you want more information on how to obtain prior authorization, please call Customer Service at 800-638-0449. Appropriate staff members who were not involved in the earlier decision will review the appeal. Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect June 12, 2018 . The RGA medical product uses BlueCard nationwide and the Regence Participating and Preferred Provider Plan (PPP) networks. We generate weekly remittance advices to our participating providers for claims that have been processed. Your Plan only pays for Covered Services received from approved, Prior Authorized Out-of-Network Providers at rates allowed under your plan. To obtain prescriptions by mail, your physician or Provider can call in or electronically send the prescription, or you can mail your prescription along with your Providence Member ID number to one of our Network mail-order Pharmacies. If you are in a situation where benefits need to be coordinated, please contact your customer service representative at800-878-4445 to ensure your Claims are paid appropriately. If the information is not received within 15 calendar days, the request will be denied. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. Filing your claims should be simple. During the first month of the grace period, your prescription drug claims will be covered according to your prescription drug benefits. The enrollment code on member ID cards indicates the coverage type. Web portal only: Referral request, referral inquiry and pre-authorization request. These prescriptions require special delivery, handling, administration and monitoring by your pharmacist. Cigna timely filing (Commercial Plans) 90 Days for Participating Providers or 180 Days for Non Participating Providers. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. Timely Filing Rule. Company information about the Regence Group-BlueCross BlueShield affiliated health care plans located in Oregon, Washington, Utah and Idaho, and serving more than 3 million subscribers. Quickly identify members and the type of coverage they have. If the first submission was after the filing limit, adjust the balance as per client instructions. All inpatient, residential, day, intensive outpatient, or partial hospitalization treatment Services, and other select outpatient Services must be Prior Authorized. 6:00 AM - 5:00 PM AST. The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. Learn about submitting claims. Please note: Capitalized words are defined in the Glossary at the bottom of the page. If you do not submit your claims through Availity Essentials, follow this process to submit your claims to us electronically. Benefits are not assignable; you will receive direct payment even if your patient signs an assignment authorization. There is a lot of insurance that follows different time frames for claim submission. Please see Appeal and External Review Rights. You can submit a marketing complaint to us by calling the phone number on the back of your member ID card or by calling 1-800-MEDICARE (1-800-633-4227). Regence Group Administrators (RGA) is a wholly owned subsidiary of Regence that provides third-party administrative services to self-funded employer groups primarily located in Oregon and Washington. Providence will complete its review and notify the requesting provider or you of its decision by the earlier of (a) 48 hours after the additional information is received or, (b) if no additional information is provided, 48 hours after the additional information was due. Claims received after 12 months will be denied for timely filing and the OGB member and Blue Cross should be held harmless. Browse value-added services & buy-up options, Prescription Drug reimbursement request form, General Medical Prior Authorization Fax Form, Carelon Medical Benefits Management (formerly AIM Specialty Health). Media Contact: Lou Riepl Regence BlueCross BlueShield of Utah Regence BlueShield of . Cigna HealthSprings (Medicare Plans) 120 Days from date of service. We probably would not pay for that treatment. This is not a complete list. Lower costs. Contacting RGA's Customer Service department at 1 (866) 738-3924. If you wish to appoint someone to act on your behalf, you must complete an appointment of representative form (PDF) and send it to us with your grievance form (PDF). Phone: 800-562-1011. We shall notify you that the filing fee is due; . Regence is the name given to Blue Cross and Blue Shield plans in four northwestern states. The total amount you will pay Out-of-Pocket in any Calendar Year for Covered Services received. If you are hearing impaired and use a Teletype (TTY) Device, please call our TTY line at 711. For standard requests, Providence Health Plan will notify your provider or you of its decision within 72 hours after receipt of the request. Effective August 1, 2020 we . On rare occasions, such as urgent or emergency situations, you may need to use an Out-of-Network Pharmacy. Search: Medical Policy Medicare Policy . Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. Para humingi ng tulong sa Tagalog, pakitawagan ang numero ng telepono ng Serbisyo sa Kostumer (Customer Service) na nakasulat sa likod ng inyong kard bilang miyembro. You may need to make multiple Copayments for a multi-use or unit-of-use container or package depending on the medication and the number of days supplied. Under no circumstances (with the exception of Emergency and Urgent Care) will we cover Services received from an Out-of-Network Provider/Facility unless we have Prior Authorized the Out-of-Network Provider/Facility and the Services received. Providence will not pay for Claims received more than 365 days after the date of Service. Other procedures, including but not limited to: Select outpatient mental health and/or chemical dependency services. During the second and third months of the grace period, your prescription drug coverage will be suspended and you will be required to pay 100 percent of the cost of your prescription drugs.
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