CurrentAnthemPolicy G-06133

Proof of Timely Filing for Reimbursement

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 language; non-material

Effective Date10/23/2025

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 fieldsRequired mailed claims log contents

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

Policy Summary

PayerAnthem

PolicyProof of Timely Filing for Reimbursement

Policy CodePolicy G-06133

Change TypeClarified language; non-material

Effective Date10/23/2025

Next Review Date

SourceLink

On This Page

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).
- Unavoidable delay in securing required supporting documentation 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 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

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

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.