![]() Highmark Blue Cross Blue Shield of Delaware timely filing limit for filing initial claims: 120 Days from the DOS Highmark BCBS timely filing limit - Delaware Premera Blue Cross Blue Shield timely filing limit for Level 2 Appeal: 15 days from the date of Level 1 appeal decisionīlue Cross Blue Shield of Arizona Advantage timely filing limitīCBS of Arizona Advantage timely filing limit for filing an initial claims: 1 year from DOSĪnthem Blue Cross timely filing limit (Commercial and Medicare Advantage plan) Eff: October 1 2019Īnthem Blue Cross timely filing limit for Filing an Initial Claims: 90 Days from the DOS Premera Blue Cross Blue Shield timely filing limit for Level 1 Appeal: 365 from the date that prompted the dispute Premera BCBS of Alaska timely filing limit for filing an initial claims: 365 Days from the DOS Premera BCBS timely filing limit - Alaska This article is for informational purposes only, and is not meant as medical advice.Anthem Blue Cross Blue Shield Timely filing limit 2019 - NamesĪnthem BCBS Time Limit for filing Claim or Appeal *Depends on the contractual terms of the network To learn more about Meritain Health, our claims processing procedures and more, contact us today! In all these ways mentioned, we’re able to generate savings during the life cycle of a claim other third party administrators (TPAs) cannot. For claims over $15,000, our high-cost claim protection program delivers an average savings of 67 percent.Meritain Health clients saved nearly $605 million on out-of-network claims in 2021-a 25 percent increase from 2020.Savings are captured on approximately 91 percent of out-of-network claims, with an average savings of 61 percent.An audit process on paid claims is also used to catch errors and maximize savings. For instance, in-network claims over $15,000 *, as well as out-of-network claims over $15,000 are subject to a line-by-line review to capture additional edits, or savings recommendations. However, we have processes tailored to high-dollar claims, plus in-network versus out-of-network. What strategies do we employ? This may depend on the amount of the claim and network terms. In addition, proactive review helps our clients address claims issues and take control of their benefits spending. To obtain the most cost-effective pricing on behalf of our clients, we utilize specific cost management strategies in the claims process. Our rule sets are designed to stay current with the market and provide deeper support for the changing complexity of self-funded plans. Additionally, strategic in-house claims editing processes are applied using proprietary claims editing software. Then, claims are evaluated, adjudicated or repriced, if necessary, and savings are applied. Does the claim date fall within the right effective dates for the employer group?.Is the member eligible for services on the claim?. ![]() This helps us determine validity of the claim, considering things like: When we first receive a claim-either electronically, by paper or manually-an initial review is always performed. Our strategic approach is how we proactively look for savings. In fact, we have a cost management strategy for most claim situations, including in-network, out-of-network, high-dollar, complex, pharmacy, fraud, waste and abuse, and dialysis claims. We focus on timely handling of claims, but also have upfront claims editing practices to help with managing costs. So, when it comes to the life cycle of a claim, here’s what you can expect to see. Luckily, at Meritain Health®, claims handling is something we know a lot about. ![]() Whether you’re an employer or a member, you might wonder what happens to a health care claim once it’s submitted.
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