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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyAnthem Proof of Timely Filing Policy Update | Open…
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    CurrentAnthemPolicy G-06133

    Proof of Timely Filing

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    Governs the documentation and criteria Anthem (California Medi-Cal managed care) uses to reconsider claims denied for late filing and describes acceptable proof and 'Good Cause' criteria for providers seeking reimbursement reconsideration.

    Policy Summary
    PayerAnthem
    PolicyProof of Timely Filing
    Policy CodePolicy G-06133
    Change TypeRevised (material)
    Effective DateJun 15, 2026
    Last ReviewOct 23, 2025
    Next Review DateN/A
    Key ActionSubmit proof of claim receipt (official mailing return receipt plus mailed claims log for mail submissions or clearinghouse assigned receipt date for electronic submissions) or demonstrate Good Cause; fax and hand-delivery signed receipts are not accepted.
    SourceLink
    POLICY UPDATE CHANGES

    Updated policy to no longer accept proof of facsimile transmission as proof of timely filing for fax submissions.

    Hand delivery will not be considered proof that the claim was received timely and the mailed claims log requirement clarified to specify 'mailed' claim log.

    9mailed claim log fields required
    6Good Cause examples
    3submission methods addressed

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    1related policies

    Timely Filing Reconsideration Criteria

    Timely Filing Reconsideration Criteria

    Criteria the health plan uses to reconsider reimbursement for claims denied for late filing:

    Reconsideration permitted when one of the following is provided:

    • Provide proof of claim receipt compliant with timely filing requirements

      • If submitted by mail: official mailing service return receipt or delivery confirmation PLUS a copy of the mailed claims log that identifies each claim included in the submission
      • If submitted electronically: the clearinghouse-assigned receipt date from reconciliation reports
      • Note: facsimile transmission and hand-delivery signed receipts/claim logs will NOT be considered acceptable proof

    • OR demonstrate Good Cause

      • If the claim includes an explanation for the delay (or other supporting evidence), the health plan will determine Good Cause based primarily on that statement or evidence

      • ANY of the following

        • Administrative error (incorrect or incomplete information furnished by official sources to the provider)
        • Retroactive enrollment where member received notification effective retroactively to or before date of service
        • Incorrect information furnished by the member resulting in filing with another payer (e.g., other health plan, Medicare, or State Medicaid)
        • Unavoidable delay in securing required supporting documentation or evidence from third parties despite reasonable efforts by the provider
        • Unusual, unavoidable, or other circumstances beyond the provider's control that demonstrate the provider could not reasonably be expected to have been aware of the need to file timely
        • Destruction or other damage of the provider's records, unless caused by the provider's willful act or intentional oversight
    Operational notes: mailed claims log must include claimant name, claimant address, claimant telephone, claimant federal tax ID, name of addressee, name of carrier, designated address, date of mailing, subscriber name, subscriber ID, member name, and date(s) of service/occurrence, total charge, and delivery method

    Billing Codes Requirement

    Billing Codes Requirementmixed
    CPT/HCPCS/RevenueClaims must use industry-standard CPT, HCPCS, and/or revenue codes supported by documentation.

    Reconsideration and Acceptable Proof

    Note

    Request reconsideration: submit acceptable proof or Good Cause

    Providers may request reconsideration of a claim denied for late filing by submitting proof that the claim was received within the plan's timely filing period or by demonstrating Good Cause. For mailed submissions, provide an official mailing service return receipt or delivery confirmation plus a mailed claims log containing the required fields. For electronic submissions, provide the clearinghouse-assigned receipt date from reconciliation reports. Fax transmission confirmations and hand-delivery signed receipts or delivery claim logs will not be accepted as proof.

    • Mail: official mailing service return receipt/delivery confirmation AND mailed claims log with required fields (name, address, telephone, federal tax ID, addressee, carrier, designated address, date of mailing, subscriber name/ID, member name, date(s) of service, total charge, delivery method).
    • Electronic: clearinghouse-assigned receipt date from reconciliation reports.
    • Not acceptable: facsimile transmission confirmations; hand-delivery signed receipts or hand-delivery claim logs.
    • If claiming Good Cause, submit an explanation or supporting evidence (examples include administrative error, retroactive enrollment, incorrect member information, unavoidable delay obtaining documentation, destruction/damage of provider records).

    Key Definitions

    inv-04: Good Cause
    Primary basis for Good CauseIf the claim includes an explanation for the delay (or other evidence), the health plan will determine Good Cause based primarily on that statement or evidence.
    Provider clarification stepIf evidence raises doubt about the statement's validity, the health plan will contact the provider for clarification or additional information.
    Administrative errorDelay due to incorrect or incomplete information furnished by official sources to the provider.
    Retroactive enrollmentMember subsequently received notification of enrollment effective retroactively to or before the date of service.
    Incorrect member informationIncorrect information furnished by the member to the provider resulting in erroneous filing with another payer (Health Insurance plan, Original Medicare, or State Medicaid).
    Delay obtaining documentation
    Policy Summary
    PayerAnthem
    PolicyProof of Timely Filing
    Policy CodePolicy G-06133
    Change TypeRevised (material)
    Effective DateJun 15, 2026
    Last ReviewOct 23, 2025
    Next Review DateN/A
    Key ActionSubmit proof of claim receipt (official mailing return receipt plus mailed claims log for mail submissions or clearinghouse assigned receipt date for electronic submissions) or demonstrate Good Cause; fax and hand-delivery signed receipts are not accepted.
    SourceLink
    On This Page
    Timely Filing Reconsideration CriteriaBilling Codes RequirementReconsideration and Acceptable ProofKey Definitions
    Unavoidable delay in securing required supporting claim documentation or evidence from third parties despite reasonable efforts by the provider.
    Destruction or damage of recordsDestruction or other damage of the provider's records, unless caused by the provider's willful act or intentional oversight.
    inv-05: Documentation of claim receipt
    Mail submissions - accepted proofOfficial mailing service return receipt or delivery confirmation PLUS a mailed claims log that identifies each claim included in the submission.
    Electronic submissions - accepted proofClearinghouse-assigned receipt date from reconciliation reports.
    Unacceptable proof - faxFacsimile transmission confirmations are not considered proof that the claim was received timely.
    Unacceptable proof - hand deliveryA claim log identifying each claim in the delivery and a copy of the signed hand-delivery receipt are not considered proof.
    Mailed claims log required fieldsMailed claims log must include claimant name/address/telephone, claimant federal tax ID, addressee, carrier, designated address, date of mailing, subscriber name/ID, member name, date(s) of service, total charge, and delivery method.