Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyBlue Cross Blue Shield - Maine timely filing polic…
    Ask Trek AI about this page
    CurrentBlue Cross Blue Shield - MainePolicy G-06133

    Proof of Timely Filing for Claims

    Customize your policy alerts

    Sign up for Blue Cross Blue Shield - Maine Policy G-06133 alerts

    Get alerted when Policy G-06133 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    This reimbursement policy governs what documentation or circumstances Blue Cross Blue Shield - Maine will accept to reconsider claims denied for late filing; it applies to providers submitting claims to the plan.

    Policy Summary
    PayerBlue Cross Blue Shield - Maine
    PolicyProof of Timely Filing for Claims
    Policy CodePolicy G-06133
    Change TypeNo material changes
    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 claim receipt (mail return receipt/delivery confirmation and mailed claims log, or clearinghouse assigned electronic receipt date) or evidence establishing Good Cause.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    mail, electronicaccepted and not accepted proof types
    6Good Cause examples

    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.

    10/23/2025
    last approval date

    Reconsideration for Timely Filing

    Reconsideration criteria for timely filing

    Covered when ALL of the following are met:

    ALL of the following

    • Accepted proof (ONE of)

      • Mail: provider provides official mailing service return receipt or delivery confirmation AND a mailed claims log that identifies each claim in the submission.
      • Electronic: provider provides the clearinghouse-assigned receipt date from reconciliation reports.
    Mailed claims log includes required fields: name and address of claimant, claimant telephone, claimant federal tax ID, name of addressee, name of carrier, designated address, date of mailing, subscriber name, subscriber ID, member name, date(s) of service/occurrence, total charge, and delivery method.
    Provider does NOT rely on the following as proof of timely receipt: fax (facsimile transmission) or hand-delivery documentation (claim log and signed receipt are not acceptable).

    OR demonstrate Good Cause (ONE of)

    • Examples of Good Cause (ONE or more)

      • 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 insurer, Original Medicare, or State Medicaid plan.
      • Unavoidable delay 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 prevented timely filing or awareness of the need to file timely.
    Reconsideration is subject to provider, state, federal, or CMS contracts and/or requirements which may indicate otherwise.

    Billing and Coding Requirements

    Billing and coding requirementsmixed
    Claims must be billed using standard CPT, HCPCS, and/or revenue codes supported by documentation

    What Providers Must Do

    Note

    Request reconsideration and provide proof of claim receipt or Good Cause

    Request a reconsideration for a claim denied for late filing by submitting acceptable proof that the claim was received within the plan's timely filing period or by demonstrating Good Cause. Acceptable proof for mailed claims is an official mailing service return receipt or delivery confirmation plus a copy of the mailed claims log; for electronic claims, provide the clearinghouse-assigned receipt date from reconciliation reports. Fax transmissions and hand-delivery documentation (claim log and signed receipt) are not acceptable proof.

    • Mailed claims: official mailing service return receipt or delivery confirmation AND a copy of the mailed claims log (log must include claimant name/address/phone, claimant TIN, addressee, carrier, designated address, date of mailing, subscriber name/ID, member name, date(s) of service, total charge, and delivery method).
    • Electronic claims: clearinghouse-assigned receipt date from reconciliation reports.
    • Not acceptable: fax facsimile transmission or hand-delivery documents (claim log and signed receipt).
    • If relying on Good Cause, provide an explanation or evidence; plan may request clarification if evidence raises doubt.

    Key Definitions

    Definitions — General Reimbursement Policy Definitions
    ScopeGeneral Reimbursement Policy Definitions (see policy for full list).
    PurposeProvides standardized terms used throughout the reimbursement policy to support consistent claims review and reconsideration decisions.
    ApplicabilityApplies to providers submitting claims to Blue Cross Blue Shield - Maine when determining acceptable documentation and definitions referenced in timely filing reconsiderations.
    LocationDefinitions appear in the policy 'Proof of Timely Filing' under the Definitions section.
    Good Cause — examples of circumstances
    Administrative errorDelay due to incorrect or incomplete information furnished by official sources to the provider.
    Policy Summary
    PayerBlue Cross Blue Shield - Maine
    PolicyProof of Timely Filing for Claims
    Policy CodePolicy G-06133
    Change TypeNo material changes
    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 claim receipt (mail return receipt/delivery confirmation and mailed claims log, or clearinghouse assigned electronic receipt date) or evidence establishing Good Cause.
    SourceLink
    On This Page
    Reconsideration for Timely FilingBilling and Coding RequirementsWhat Providers Must DoKey Definitions
    Destruction or damage of the provider's records (unless caused by the provider's willful act or unintentional oversight).
    Retroactive enrollmentMember subsequently received notification of enrollment effective retroactively to or before the date of service.
    Incorrect member informationMember provided incorrect information to the provider resulting in erroneous filing with another insurer, Original Medicare, or State Medicaid plan.
    Unavoidable delay securing documentationDelay in obtaining required supporting claim documentation or evidence from one or more third parties despite reasonable efforts by the provider.
    Destruction of recordsDestruction or other damage of the provider's records, unless caused by the provider's willful act or unintentional oversight.
    Other unusual or unavoidable circumstancesUnusual, unavoidable, or other circumstances beyond the provider's control that show the provider could not reasonably be expected to have been aware of the need to file timely.