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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyAnthem Timely Filing Policy Update | OpenPayer
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    CurrentAnthemPolicy G-06133

    Proof of Timely Filing for Claims

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    Defines what documentation Anthem New York Medicaid accepts as proof that a claim was received within timely filing requirements and the circumstances under which Good Cause for late filing may be granted; applies to providers submitting claims to Anthem for NY Medicaid.

    Policy Summary
    PayerAnthem
    PolicyProof of Timely Filing for Claims
    Policy CodePolicy G-06133
    Change TypeNo material change
    Effective DateOct 23, 2025
    Last ReviewOct 23, 2025
    Next Review Date
    Key ActionRequest reconsideration of a late-filed claim by providing proof of claim receipt or demonstrating Good Cause.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    NY Medicaidprogram applicability
    Mail/Electronic/Fax/Handsubmission methods
    MultipleGood Cause examples
    2006–2025revision history

    Timely Filing and Reconsideration Criteria

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Timely Filing Reconsideration Criteria

    Covered when ALL of the following are met:

    Health plan will reconsider a claim not accepted due to failure to meet timely filing requirements unless contracts or requirements indicate otherwise.

    Proof of receipt (provide ONE of the following as applicable)

    • Mail: official mailing service return receipt or delivery confirmation AND provider-maintained mailed claims log identifying each claim in the submission.
    • Electronic: clearinghouse-assigned receipt date from reconciliation reports.

    Unacceptable proofs (these will NOT be considered proof of timely receipt)

    • Facsimile transmission (fax).
    • Hand-delivery: a claim log identifying each claim included and a copy of the signed receipt.

    Mailed claims log required fields

    • Name of claimant.
    • Address of claimant.
    • Telephone number of claimant.
    • Claimant's federal tax identification number.
    • Name of addressee.
    • Name of carrier.
    • Designated address.

    Good Cause (provide ONE or more of the following reasons/evidence)

    • Provider includes an explanation for the delay (or other evidence) — health plan will determine Good Cause based primarily on that statement or evidence.
    • If evidence raises doubt, health plan will contact provider for clarification or additional information needed to determine Good Cause.
    • Administrative error (incorrect or incomplete information furnished by official sources to the provider).
    • Retroactive enrollment (member received notification of enrollment effective retroactively to or before the date of service).
    • Incorrect information furnished by the member to the provider resulting in erroneous filing with another health plan, Original Medicare, or State Medicaid plan.
    • Unavoidable delay in securing required supporting documentation or evidence from third parties despite reasonable efforts by the provider.

    Coding Guidance

    General coding guidancemixed
    Standard correct coding applies

    Provider Submission and Reconsideration Steps

    Prior Authorization

    Reconsideration for Timely Filing

    Provider may request reconsideration of a claim denied for failure to meet timely filing requirements by providing a compliant date of claim receipt or by demonstrating Good Cause for the late filing.

    Documentation Required

    Mail Submission Proof Required

    If the claim was submitted by mail, the provider must submit the official mailing service return receipt or delivery confirmation and a provider-maintained mailed claims log identifying each claim in the submission.

    • Mailed claims log must include: name, address, telephone number and federal tax ID of claimant; name of addressee and carrier; designated address; date of mailing; subscriber name and ID; member name; dates of service, total charge, and delivery method.
    Documentation Required

    Electronic Submission Proof

    If the claim was submitted electronically, provide the clearinghouse-assigned receipt date from the reconciliation reports as proof of receipt.

    Denial Risk

    Not Acceptable Proof of Receipt

    Facsimile transmission and a hand-delivery claim log with a signed receipt are not considered acceptable proof that a claim was received timely.

    Key Definitions

    Documentation of claim receipt
    DefinitionDocumentation of claim receipt is the evidence a provider must submit to show a claim was received within the time period in the Claims Timely Filing policy.
    Mail submission proofOfficial mailing service return receipt or delivery confirmation plus a provider-maintained mailed claims log identifying each claim in the submission.
    Electronic submission proofClearinghouse-assigned receipt date from reconciliation reports showing the submission date.
    Not acceptable as proofFacsimile transmission (fax) and hand-delivery claim log with signed receipt are not considered proof of timely receipt.
    Mailed claims log required fieldsName/address/telephone of claimant; claimant federal tax ID; name of addressee; name of carrier; designated address; date of mailing; subscriber name and ID; member name; dates of service/occurrence; total charge; delivery method.
    Good Cause
    DefinitionGood Cause is the justification a provider may submit to explain a filing delay; the health plan will evaluate the explanation and any supporting evidence to determine Good Cause.
    Primary evaluationIf the claim includes an explanation (or other evidence) for the delay, the health plan will base the Good Cause determination primarily on that statement or evidence.
    Provider follow-upIf evidence raises doubt about the explanation's validity, the health plan will contact the provider for clarification or additional information.
    Examples of circumstances that may establish Good CauseAdministrative error; retroactive enrollment; incorrect member information causing misfiling with another plan; unavoidable delay obtaining required supporting documentation despite reasonable efforts; unusual or unavoidable circumstances beyond provider control; destruction or damage of provider records (unless caused by provider willful act or unintentional oversight).
    Policy Summary
    PayerAnthem
    PolicyProof of Timely Filing for Claims
    Policy CodePolicy G-06133
    Change TypeNo material change
    Effective DateOct 23, 2025
    Last ReviewOct 23, 2025
    Next Review Date
    Key ActionRequest reconsideration of a late-filed claim by providing proof of claim receipt or demonstrating Good Cause.
    SourceLink
    On This Page
    Timely Filing and Reconsideration CriteriaCoding GuidanceProvider Submission and Reconsideration StepsKey Definitions
    Date of mailing.
  1. Subscriber name and Subscriber ID number.
  2. Member's name.
  3. Date(s) of service/occurrence, total charge, and delivery method.
  4. 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.
  5. Destruction or other damage of the provider's records, unless caused by the provider's willful act or unintentional oversight.