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    OpenPayerPolicy UpdatesReimbursement/Payment PolicyAnthem timely filing policy update | OpenPayer
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    CurrentAnthemPolicy G-06133

    Proof of Timely Filing for Reimbursement

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    Defines what documentation or circumstances the health plan (Anthem/AMH Health, LLC Medicare Advantage) will accept to reconsider claims denied for late filing and outlines acceptable proof and good cause criteria for providers.

    Policy Summary
    PayerAnthem
    PolicyProof of Timely Filing for Reimbursement
    Policy CodePolicy G-06133
    Change TypeClarified languagenon-material
    Effective Date10/23/2025
    Last ReviewOct 23, 2025
    Next Review Date
    Key ActionRequest reconsideration of a claim denied for late filing by providing proof of timely receipt (mail return receipt/delivery confirmation plus mailed claim log for mailed submissions or clearinghouse receipt date for electronic submissions) or demonstrate Good Cause.
    SourceLink
    POLICY UPDATE CHANGES

    Policy title updated and policy language updated; clarified that fax and hand delivery are not considered proof of timely receipt and added the word 'mailed' for claim log.

    10/23/2025Effective and last approval date
    G-06133Policy identifier
    6 examplesGood Cause scenarios listed
    11 fields

    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.

    Required mailed claims log contents

    Timely Filing Reconsideration Criteria

    Timely Filing Reconsideration Criteria

    The health plan will reconsider reimbursement of claims denied for late filing when the provider supplies acceptable proof of timely receipt or demonstrates Good Cause.

    Acceptable proof of timely receipt

    • Mail submissions

      • Provide official mailing service return receipt or delivery confirmation.
      • Provide a copy of the mailed claim log that identifies each claim included in the submission.

      • Mailed claims log must include name/address/telephone/Federal TIN/addressee/carrier/designated address/date of mailing/subscriber name/ID/member name/date(s) of service/total charge/delivery method.

    • Electronic submissions

      • Provide the clearinghouse-assigned receipt date from reconciliation reports.

    • Unacceptable proof

      • Fax transmissions are not considered proof of timely receipt.
      • Hand delivery documentation (a claim log and signed receipt) is not considered proof of timely receipt.

    Good Cause

    • Provider submits an explanation for the delay or other evidence that establishes the reason; the health plan will determine Good Cause primarily on that statement or evidence.
    • If evidence raises doubt, the health plan will contact the provider for clarification or additional information to make a Good Cause determination.

    • Examples of circumstances that may establish 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 plan (Original Medicare or State Medicaid).

    Plan discretion

    • The health plan will reconsider reimbursement when provider demonstrates timely receipt or Good Cause, unless other care provider, state, federal, or CMS contracts and/or requirements indicate otherwise.

    Coding and Documentation Requirements

    Coding requirementmixed
    Standard correct coding applies; claims should use CPT, HCPCS, and/or revenue codes supported by documentation.
    Mailed claims log required fields
    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

    Actions to Request Reconsideration

    Note

    Reconsideration for Timely Filing — Submit Proof or Good Cause

    Request reconsideration of a claim denied for late filing by submitting the required proof of timely receipt or demonstrating Good Cause. For mailed claims, provide an official mailing service return receipt or delivery confirmation and a copy of the mailed claim log that identifies each claim; for electronic claims, provide the clearinghouse-assigned receipt date from reconciliation reports. Note that fax transmissions and hand delivery (a claim log and signed receipt) are not acceptable proof.

    • For mailed submissions: official mailing service return receipt or delivery confirmation PLUS a copy of the mailed claim log containing required fields (name/address/telephone/Federal TIN/addressee/carrier/designated address/date of mailing/subscriber name/ID/member name/date(s) of service/total charge/delivery method).
    • For electronic submissions: clearinghouse-assigned receipt date from reconciliation reports.
    • Fax transmissions and hand delivery (claim log and signed receipt) will NOT be considered proof of timely receipt.
    • If claiming Good Cause, provide an explanation and supporting evidence; the plan may request clarification if evidence raises doubt.

    Definitions

    Definitions — General Reimbursement Policy
    Definitions referenceGeneral Reimbursement Policy Definitions (see policy for full definitions).
    ScopeReconsideration of claims denied for late filing when provider supplies acceptable proof of timely receipt or demonstrates Good Cause.
    Proof of receipt — MailOfficial mailing service return receipt or delivery confirmation plus a copy of the mailed claim log identifying each claim.
    Proof of receipt — ElectronicClearinghouse assigned receipt date from reconciliation reports.
    Unacceptable proofFax transmissions and hand delivery (a claim log and signed receipt) are not considered proof of timely receipt.
    Policy Summary
    PayerAnthem
    PolicyProof of Timely Filing for Reimbursement
    Policy CodePolicy G-06133
    Change TypeClarified languagenon-material
    Effective Date10/23/2025
    Last ReviewOct 23, 2025
    Next Review Date
    Key ActionRequest reconsideration of a claim denied for late filing by providing proof of timely receipt (mail return receipt/delivery confirmation plus mailed claim log for mailed submissions or clearinghouse receipt date for electronic submissions) or demonstrate Good Cause.
    SourceLink
    On This Page
    Timely Filing Reconsideration CriteriaCoding and Documentation RequirementsActions to Request ReconsiderationDefinitions
    Unavoidable delay in securing required supporting documentation from third parties despite reasonable efforts by the provider.
  1. 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.
  2. Destruction or other damage of the provider's records, unless caused by the provider's willful act or unintentional oversight.
    3. Date of mailingDate of mailing
    Subscriber nameSubscriber name
    Subscriber ID numberSubscriber ID number
    Member's nameMember's name; Date(s) of service/occurrence, total charge, and delivery method