CurrentBlue Cross Blue Shield - WisconsinPolicy G-06133

Proof of Timely Filing (Reimbursement Policy)

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Governs reconsideration of claims denied for failure to meet timely filing requirements and outlines what constitutes proof of timely receipt and what may demonstrate Good Cause; applies to providers submitting claims to Anthem Blue Cross and Blue Shield/Anthem Medicare Advantage (including Blue Cross Blue Shield - Wisconsin plans administered by Anthem as noted).

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyProof of Timely Filing (Reimbursement Policy)

Policy CodePolicy G-06133

Change TypeClarified unacceptable proof (operational guidance)

Effective DateNov 19, 2021

Last ReviewSep 27, 2023

Next Review Date

Key ActionProviders may request reconsideration of untimely claims by submitting proof of claim receipt (official mailing service return receipt/delivery confirmation plus mailed claims log for mailed claims, or clearinghouse assigned receipt date for electronic claims) or by demonstrating Good Cause.

SourceLink

POLICY UPDATE CHANGES

The policy specifies that facsimile transmission and hand delivery (a claim log and signed receipt) are not considered proof the claim was received timely.

1policy governs timely filing reconsideration process

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CurrentBlue Cross Blue Shield - WisconsinPolicy G-06133

Proof of Timely Filing (Reimbursement Policy)

Customize your policy alerts

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

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

Monitor payer policy activity

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Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyProof of Timely Filing (Reimbursement Policy)

Policy CodePolicy G-06133

Change TypeClarified unacceptable proof (operational guidance)

Effective DateNov 19, 2021

Last ReviewSep 27, 2023

Next Review Date

SourceLink

POLICY UPDATE CHANGES

The policy specifies that facsimile transmission and hand delivery (a claim log and signed receipt) are not considered proof the claim was received timely.

1policy governs timely filing reconsideration process

Timely Filing Reconsideration Criteria

Anthem Medicare Advantage will reconsider claims denied for failure to meet timely filing requirements when the provider either documents timely receipt within the applicable filing period or demonstrates Good Cause.

ALL of the following

Documentation of timely receipt
- Mailed claims: provide an official mailing service return receipt or delivery confirmation PLUS a mailed claims log that identifies each claim included in the submission.
  Mailed claims log must include claimant name, claimant address, claimant telephone number, claimant federal tax identification number, name of addressee, name of carrier, designated address, date of mailing, subscriber name, subscriber ID number, member name, date(s) of service/occurrence, total charge, and delivery method.
- Electronic claims: provide the clearinghouse-assigned receipt date from reconciliation reports.
Documentation NOT acceptable as proof of timely receipt
- Facsimile transmission is not acceptable proof of timely receipt.
- Hand delivery documentation (a claim log identifying each claim and a copy of the signed receipt) is not acceptable proof of timely receipt.

Or demonstrate Good Cause

Provider submits an explanation for the delay or other evidence establishing the reason; Anthem will determine Good Cause based primarily on that statement or evidence.
If evidence raises doubt about validity, Anthem may contact the provider for clarification or additional information necessary 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 resulting in erroneous filing with another plan or with original Medicare.

General Coding Requirement

General coding requirementmixed

Claims must be submitted using industry standard codes (CPT, HCPCS, revenue codes) and be supported in the medical record.

Provider Reconsideration and Proof Requirements

Prior Authorization

How to Request Timely‑Filing Reconsideration and Acceptable Proof

Request reconsideration by submitting either acceptable proof that the claim was received within the applicable timely filing period or documentation demonstrating Good Cause. For mailed claims, include an official mailing service return receipt or delivery confirmation plus a mailed claims log that identifies each claim in the submission. For electronic claims, provide the clearinghouse-assigned receipt date from reconciliation reports. Do not submit facsimile transmissions or hand-delivery logs/signed receipts as proof of timely receipt. Good Cause may be supported by a provider explanation or other evidence; Anthem may request clarification if the evidence raises doubt.

Mailed claims: official mailing service return receipt/delivery confirmation AND a mailed claims log listing each claim and required claim-log fields (e.g., claimant name, address, tax ID, date of mailing, subscriber name/ID, dates of service, total charge).
Electronic claims: clearinghouse-assigned receipt date from reconciliation reports.
Unacceptable proof: facsimile transmission; hand delivery documentation (claim log and signed receipt).
If claiming Good Cause, provide an explanation/evidence; Anthem will evaluate and may request additional information.

Definitions — Proof of Receipt & Good Cause

Proof of Claim Receipt

Accepted — Mailed claimsOfficial mailing service return receipt or delivery confirmation PLUS a mailed claims log identifying each claim included.

Accepted — Electronic claimsClearinghouse-assigned receipt date from reconciliation reports.

Unacceptable — FaxFacsimile transmission is not considered proof the claim was received timely.

Unacceptable — Hand deliveryA claim log and signed receipt from hand delivery are not considered proof the claim was received timely.

Mailed claims log requirementsLog 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.

Good Cause — Examples and Definitions