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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 for Claims Reconsideration

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    Defines what documentation and circumstances Anthem Ohio Medicaid requires to reconsider claims denied for untimely filing, and describes acceptable proof of receipt and 'good cause' reasons applicable to providers submitting claims to Anthem Ohio Medicaid.

    Policy Summary
    PayerAnthem
    PolicyProof of Timely Filing for Claims Reconsideration
    Policy CodePolicy G-06133
    Change TypeNo material changes
    Effective Date10/23/2025
    Last ReviewOct 23, 2025
    Next Review Date
    Key ActionSubmit proof of claim receipt (clearinghouse assigned receipt date for electronic claims; official mailing return receipt/delivery confirmation plus mailed claims log for mailed claims).
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    Clearinghouse dateacceptable electronic proof
    Fax/hand-deliverynot accepted as proof
    12 elements

    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.

    mailed claims log fields
    7 examplesGood Cause examples
    10/23/2025most recent review

    Reconsideration for Untimely Claims - Criteria

    Reconsideration Criteria for Untimely Claims

    Anthem will reconsider untimely claims when providers meet documentation and Good Cause requirements.

    ALL of the following

    • Acceptable proof

      • Electronic submissions: clearinghouse assigned receipt date from reconciliation reports is acceptable proof.
      • Mailed submissions: official mailing service return receipt or delivery confirmation PLUS a mailed claims log containing required elements.

    • Unacceptable proof

      • Fax transmission is not acceptable proof.
      • Hand-delivery claim logs and signed receipts are not acceptable proof.
    The mailed claims log must include: name of claimant; address of claimant; telephone number of claimant; claimant's federal tax identification number; name of addressee; name of carrier; designated address; date of mailing; subscriber name; subscriber ID number; member name; date(s) of service/occurrence, total charge, and delivery method.
    Provider must demonstrate Good Cause by submitting an explanation or other evidence to establish the reason for the delay; the health plan will determine Good Cause primarily from that statement or evidence and may contact the provider for clarification if the evidence raises doubt.

    Examples of circumstances that may constitute Good Cause

    • Administrative error, such as incorrect or incomplete information furnished by official sources to the provider.
    • Retroactive enrollment where the member subsequently 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 plan or Original Medicare or State Medicaid plan.
    • 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 unintentional oversight.

    Coding and Claim Log Requirements

    Coding requirementmixed
    Standard correct coding applies; use CPT, HCPCS, revenue codes as appropriate.
    Mailed claims log elements
    Name of claimantName of claimant
    Address of claimantAddress of claimant
    Telephone number of claimantTelephone number of claimant
    Claimant's federal tax identification numberClaimant's federal tax identification number
    Name of addresseeName of addressee
    Name of carrierName of carrier
    Designated addressDesignated address

    What Providers Must Submit for Reconsideration

    Documentation Required

    Submit proof of claim receipt and evidence of Good Cause for untimely claims

    Provide proof that the claim was received within the applicable timely filing period and, if filing beyond the timely filing limits, submit a statement or evidence establishing Good Cause. For electronic claims, include the clearinghouse-assigned receipt date from reconciliation reports. For mailed claims, include an official mailing service return receipt or delivery confirmation plus a mailed claims log containing the required elements listed below. Expect the health plan to contact you for clarification or additional information if submitted evidence raises questions about Good Cause.

    • Electronic submissions: include clearinghouse-assigned receipt date from reconciliation reports (acceptable proof) [see chunk 3].
    • Mailed submissions: include official mailing service return receipt/delivery confirmation plus a mailed claims log (must include name/address/telephone/federal tax ID of claimant; name of addressee; name of carrier; designated address; date of mailing; subscriber name and ID; member name; date(s) of service, total charge, and delivery method) [see chunk 3].
    • Do not use fax transmission, hand-delivery claim logs, or signed hand-delivery receipts as proof of timely receipt (these are not acceptable) [see chunk 3].
    • If filing beyond timely limits, provide an explanation or other evidence to establish Good Cause; the health plan will base its determination primarily on that statement/evidence and may request clarification if there is doubt [see chunk 4].

    Definitions and Good Cause

    Definitions
    Referenced definitionsGeneral Reimbursement Policy Definitions (see Definitions section)
    ScopeDefinitions apply to reimbursement and timely filing policies and referenced terms used in this document
    LocationSee General Reimbursement Policy Definitions for standard terms used throughout the policy
    Good Cause — circumstances that may justify late filing
    Provider explanation primary basisIf the claim includes an explanation or other evidence for the delay, the health plan will determine Good Cause based primarily on that statement or evidence.
    Plan may request clarificationIf evidence raises doubt about validity, the health plan will contact the provider for clarification or additional information to make a Good Cause determination.
    Policy Summary
    PayerAnthem
    PolicyProof of Timely Filing for Claims Reconsideration
    Policy CodePolicy G-06133
    Change TypeNo material changes
    Effective Date10/23/2025
    Last ReviewOct 23, 2025
    Next Review Date
    Key ActionSubmit proof of claim receipt (clearinghouse assigned receipt date for electronic claims; official mailing return receipt/delivery confirmation plus mailed claims log for mailed claims).
    SourceLink
    On This Page
    Reconsideration for Untimely Claims - CriteriaCoding and Claim Log RequirementsWhat Providers Must Submit for ReconsiderationDefinitions and Good Cause
    Date of mailingDate of mailing
    Subscriber name and Subscriber ID numberSubscriber name; Subscriber ID number
    Member nameMember's name
    Date(s) of service, total charge, and delivery methodDate(s) of service/occurrence, total charge, and delivery method
    Administrative errorAdministrative error: incorrect or incomplete information furnished by official sources to the provider.
    Retroactive enrollmentRetroactive enrollment: member 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 health plan, Original Medicare, or State Medicaid plan.
    Unavoidable delay obtaining documentationUnavoidable delay in securing required supporting claim documentation or evidence from third parties despite reasonable efforts by the provider.
    Destruction of records/unusual circumstancesUnusual or unavoidable circumstances beyond provider control, or destruction/damage of provider records (unless caused by provider).