CurrentBlue Cross Blue Shield - North CarolinaPolicy G-06133

Proof of Timely Filing for Claims

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This policy governs how Blue Cross and Blue Shield of North Carolina (including Healthy Blue Medicaid) will reconsider claims denied for late filing when providers can demonstrate timely receipt or establish Good Cause; it applies to providers submitting claims to Blue Cross NC.

Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyProof of Timely Filing for Claims

Policy CodePolicy G-06133

Change TypeNo material changes (administrative clarification)

Effective DateOct 23, 2025

Last ReviewOct 23, 2025

Next Review Date

Key ActionProvide official mailing service return receipt and a mailed claims log or clearinghouse assigned receipt date to request reconsideration of untimely claims.

SourceLink

POLICY UPDATE CHANGES

10/23/2025 Review approved and effective: no changes

11/19/2021 Review approved and effective: policy language updated; specified that fax and hand delivery are not considered proof and added the word 'mailed' for claim log.

2accepted proof methods

2rejected proof methods

6+mailed claim-log fields

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CurrentBlue Cross Blue Shield - North CarolinaPolicy G-06133

Proof of Timely Filing for Claims

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Sign up for Blue Cross Blue Shield - North Carolina Policy G-06133 alerts

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

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Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyProof of Timely Filing for Claims

Policy CodePolicy G-06133

Change TypeNo material changes (administrative clarification)

Effective DateOct 23, 2025

Last ReviewOct 23, 2025

Next Review Date

Key ActionProvide official mailing service return receipt and a mailed claims log or clearinghouse assigned receipt date to request reconsideration of untimely claims.

SourceLink

POLICY UPDATE CHANGES

10/23/2025 Review approved and effective: no changes

11/19/2021 Review approved and effective: policy language updated; specified that fax and hand delivery are not considered proof and added the word 'mailed' for claim log.

2accepted proof methods

2rejected proof methods

6+mailed claim-log fields

Reconsideration Criteria for Timely Filing

Reconsideration criteria

Reconsideration of a claim denied for untimely filing is allowed when ALL of the following criteria are met:

ALL of the following

ONE of
- ALL of the following
  - If submitted by mail: provider must provide an official mailing service return receipt or delivery confirmation AND a copy of the mailed claims log identifying each claim included in the submission.
  - If submitted electronically: provider must provide the clearinghouse-assigned receipt date from reconciliation reports.
- OR
  - Good Cause may be established by an explanation for the delay or other supporting evidence; the health plan will evaluate the statement/evidence and may request clarification or additional information if validity is in doubt.
  - Good Cause examples (one or more may apply)
    Administrative error such as incorrect or incomplete information furnished by official sources to the provider.
    Retroactive enrollment where the member later receives 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 health plan, Original Medicare, or a state Medicaid plan.
    Unavoidable delay in securing required supporting claim 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.

Mailed claims log requirements: when relying on mailed proof, the claims log must include name of claimant; claimant address; claimant telephone number; claimant federal tax identification number; name of addressee; name of carrier; designated address; date of mailing; subscriber name and subscriber ID number; member name; date(s) of service/occurrence; total charge; and delivery method.

The following are NOT acceptable as proof of timely receipt: facsimile transmission (fax) and hand-delivery documentation such as a claim log and a signed receipt.

Coding Guidance

Coding guidancemixed

Standard correct coding applies

Provider Submission & Proof Requirements

Denial Risk

Reconsideration triggers

Health plan will reconsider reimbursement for claims not accepted for untimely filing when the provider can provide a date of claim receipt that complies with applicable timely filing requirements or can demonstrate Good Cause for the filing delay.

Documentation Required

Acceptable proof of receipt

Provide acceptable proof that the claim was received within the plan's timely filing period: if mailed, supply the official mailing service return receipt or delivery confirmation plus a copy of the mailed claims log identifying each claim; if electronic, supply the clearinghouse-assigned receipt date from reconciliation reports.

Mail: official mailing service return receipt or delivery confirmation AND a copy of the mailed claims log identifying each claim in the submission.
Electronic: clearinghouse-assigned receipt date from reconciliation reports.

Definitions

Definitions — General Reimbursement Policy Definitions (referenced)

Definitions referenceGeneral Reimbursement Policy Definitions as referenced in this policy (see internal Definitions section).

Scope of definitionsApplies to terms used throughout this reimbursement policy for proof of timely filing and reconsideration procedures.

Where to find full textFull, authoritative definitions are located in the General Reimbursement Policy Definitions section of Policy G-06133.

Use in claims processingDefinitions guide interpretation of acceptable proof, Good Cause, and timely filing periods for claim reconsideration.

Cross-reference guidanceReferenced definitions should be used alongside related policies (Claims Timely Filing; Corrected Claims; Eligible Billed Charges).