Payers set their timely filing limit based on the date of service rendered. This time frame mayĮven vary for different plans within the same insurance carrier. Different payers will haveĭifferent timely filing limits some payers allow 90 days for a claim to beįiled, while others will allow as much as a year. Which a claim must be submitted to a payer. All Rights Reserved.In medical billing, a timely filing limit is the timeframe within © Copyright 2018 Health Care Service Corporation.
If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.Ī Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by independent third-party vendors such as Availity. Availity provides administrative services to BCBSTX. If you have any questions regarding this process, please contact the BCBSTX Medicaid Network Department at 1-85 or via email at is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals.
#Blue cross timely filing manual#
If you file a claim with the wrong insurance carrier and then provide documentation verifying the initial claim filing was within 95 days of the date of the other carrier’s denial letter or RA form, BCBSTX will process your claim without denying it for failure to file within filing time limits.Ĭlaim and billing guidelines can be found in Chapters 5-7 of the STAR Kids provider manual and Chapters 6-8 in the STAR/CHIP manual. If Medicaid’s allowable is greater than the primary insurance payment, then the difference will be paid. Additional funds will pay according to the Texas Medicaid fee schedule, which means if the primary insurance payer pays more than Medicaid’s allowable for the service, then provider reimbursement is $0. Please remember that if a commercial payer exists, Medicaid is always the payer of last resort. If you use a different vendor, please contact them with your questions about filing BCBSTX as secondary.
#Blue cross timely filing how to#
If you have questions about how to file electronic secondary claims with BCBSTX, you may contact BCBSTX’s Provider eBusiness Consultants at If you need assistance from Availity (BCBSTX’s claims clearinghouse), please call 1-80 or visit. Loop 2430 – Line Adjudication Information (if the primary claim was paid by the primary payer and service level adjustments were made at the service line level).Loop 2320 – Claim Level Adjustments (if the primary claim was paid by the primary payer and claim level adjustments were made at the claim level).Loop 2320 – Other Subscriber Information.Loop 2330B – Other Payer Secondary Identifier.
When submitting electronic BCBSTX Medicaid claims as secondary, ensure the following is included: Submitting Secondary Claims Electronically When submitting COB claims, specify the other coverage in: We cannot process the claim without this specific information. Please make sure that the information you submit explains any coding listed on the other carrier’s RA or letter.
Submitting Secondary Claims to BCBSTX via Paper Claim Forms BCBSTX must receive Coordination of Benefits (COB) claims within 95 days from the date on the other carrier’s or program’s Remittance Advice (RA) or letter of denial of coverage. Secondary claims may be submitted to BCBSTX by paper (using the CMS-1500 and UB-04 claim forms), or electronically via Availity® or your preferred web vendor. When applicable, Blue Cross and Blue Shield of Texas (BCBSTX) coordinates benefits with other carriers and programs that a member may have for coverage, including Medicare. To keep the cash flowing, it’s important to understand secondary billing. November 2018 How to Keep the Cash Flowing: Billing BCBSTX Medicaid as a Secondary Insurance
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