CurrentAnthemPolicy G-06133

Reimbursement Policy Proof of Timely Filing

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Describes what documentation Anthem HealthKeepers requires to reconsider claims denied for late filing and the circumstances under which 'Good Cause' will be accepted; applies to providers submitting claims to Anthem HealthKeepers Medicaid products in Virginia.

Policy Summary

PayerAnthem

PolicyProof of Timely Filing

Policy CodePolicy G-06133

Change TypeOperational — material

Effective DateOct 23, 2025

Last ReviewOct 23, 2025

Next Review Date

Key ActionRequest reconsideration of a denied late-filed claim by submitting proof of timely receipt (mail return receipt and claim log, clearinghouse receipt for electronic, facsimile transmission for fax, or signed receipt and claim log for hand delivery) and evidence of Good Cause.

SourceLink

POLICY UPDATE CHANGES

Updated policy to accept proof of facsimile transmission as proof of timely filing for fax submissions and accept a claim log that identifies each claim included in the delivery and a copy of the signed receipt acknowledging hand-delivery as proof of timely filing.

6+Good Cause examples listed

4Acceptable proof methods

11Policy history entries

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CurrentAnthemPolicy G-06133

Reimbursement Policy Proof of Timely Filing

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Policy Summary

PayerAnthem

PolicyProof of Timely Filing

Policy CodePolicy G-06133

Change TypeOperational — material

Effective DateOct 23, 2025

Last ReviewOct 23, 2025

Next Review Date

SourceLink

POLICY UPDATE CHANGES

6+Good Cause examples listed

4Acceptable proof methods

11Policy history entries

Reconsideration Conditions

Reconsideration conditions

Reimbursement will be reconsidered when ALL of the following are met:

ALL of the following

ALL of the following
- By mail: Official mailing service return receipt or delivery confirmation PLUS a copy of the claim log that identifies each claim included in the submission.
- Electronically: Clearinghouse‑assigned receipt date from reconciliation reports.
- By fax: Facsimile transmission as proof of receipt.
- By hand delivery: Claim log that identifies each claim included in the delivery AND a copy of the signed receipt acknowledging delivery.

ALL of the following

Provider demonstrates Good Cause for the filing delay by providing an explanation or evidence; the health plan will determine Good Cause based primarily on the provider's statement or evidence and may request clarification if doubt exists.
Examples of Good Cause (one or more may apply)
- Administrative error (e.g., incorrect or incomplete information furnished by official sources to the provider).
- Retroactive enrollment where member received notification effective retroactively to or before the date of service.
- Incorrect information furnished by the member resulting in erroneous filing with another payer (Original Medicare, another health plan, or State Medicaid).
- Unavoidable delay in securing required supporting claim documentation or evidence from third parties despite reasonable efforts by the provider.

When both proof of receipt and Good Cause are provided, the health plan will reconsider reimbursement unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise.

Coding and Claim Log Requirements

Coding requirementmixed

Standard correct coding applies; use CPT, HCPCS, revenue codes as appropriate and supported by documentation.

Required claim log fields for mailed submissions

Claimant detailsName, address, telephone number, and claimant's federal tax identification number

Addressee and carrier detailsName of addressee, name of carrier, and designated address

Date of mailingDate of mailing for the submission

Subscriber and member informationSubscriber name, subscriber ID number, and member's name

Service and charge detailsDate(s) of service/occurrence, total charge, and delivery method

How to Request Reconsideration

Documentation Required

Submit proof of timely receipt plus Good Cause evidence to request reconsideration

To request reconsideration of a claim denied for late filing, the provider must submit both proof that the claim was received within the applicable timely‑filing period and evidence establishing Good Cause for the delay. Acceptable proof of receipt and Good Cause documentation will be evaluated by the health plan and may be supplemented with clarification requests if the evidence raises doubts.

Provide a date of claim receipt compliant with applicable timely filing requirements (acceptable receipt documentation varies by submission method).
Provide documentation or an explanation demonstrating Good Cause as defined by the policy (see examples such as administrative error, retroactive enrollment, incorrect member information, unavoidable delays obtaining supporting documentation, destruction of records not caused by the provider, or other unavoidable circumstances).
Be prepared to respond to health plan requests for clarification or additional information if the evidence does not clearly establish Good Cause.

Key Definitions

Definition of '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.

Clarification if doubtfulIf evidence raises doubt about validity, the health plan will contact the provider for clarification or additional information needed for a Good Cause determination.

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 from the member resulting in filing with another insurer (e.g., another health plan, Original Medicare, or State Medicaid).

Unavoidable delays obtaining documentation