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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyBlue Cross Blue Shield WI timely-filing proof | Op…
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    CurrentBlue Cross Blue Shield - WisconsinPolicy N/A

    Timely Filing — Acceptable Forms of Proof

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    Lists acceptable forms of proof to validate that a facility submitted a claim to Anthem/Blue Cross Blue Shield Wisconsin within timely filing limits; applies to facilities and billers submitting claims to BCBSWI/Anthem.

    Policy Summary
    PayerBlue Cross Blue Shield - Wisconsin
    PolicyTimely Filing — Acceptable Forms of Proof
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionSubmit acceptable proof showing claim submission to Anthem within timely filing limits (clearinghouse reports, Availity Level 2 status, claim denial/RA/EOB, dated requests, computer-generated transactions, hard copy documentation, or proof of member billing).
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    multipleacceptable proof types
    within limitsdate requirement
    requiredsupporting details

    Verification Criteria for Acceptable Proof

    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.

    Verification criteria for acceptable proof

    To verify timely filing, one or more of the following proofs must be provided and must demonstrate submission to Anthem within the filing limit:

    Electronic clearinghouse report showing either (a) the actual Anthem response to the submission, (b) a positive acceptance message from Anthem, or (c) a facility/clearinghouse report objectively demonstrating the claim was submitted to Anthem; submission dates must be included and within the filing limits from the date(s) of service.
    Availity Level 2 Status: Level 2 Status Report generated by Availity EDI Gateway demonstrating the claim was submitted to Anthem; submission dates must be included and within the filing limits from the date(s) of service.
    Anthem denial / RA / EOB: Claim denial letter or Remittance Advice (RA) / Explanation of Benefits (EOB) from Anthem that includes the Anthem letter date, verifies member information and dates of service, and demonstrates the facility's submission was within the filing limit.
    Other insurer denial / RA / EOB: Denial letter or RA/EOB from another insurer on valid letterhead and dated, demonstrating that submission to the other insurer occurred within Anthem's timely filing limit; must allow calculation back to confirm the facility's submission to Anthem was within the filing limit.
    Dated request for information or patient billing history: Dated requests for additional information or patient billing history that include dates, follow-up attempt dates, names and pertinent details showing follow-up attempts were made within the timely filing limit.
    Computer-generated transaction or hard-copy documentation: Computer-generated claim transaction or hard copy (e.g., ledger or code listing) indicating correct Anthem address and including a complete billing history demonstrating submission to Anthem within the filing limit.
    EDI claims with error evidence: Anthem letter indicating the original EDI submission was within the filing limit; or inclusion of a batch number or error report that verifies the original EDI submission to Anthem occurred within the filing limit.

    What Providers Must Submit

    Documentation Required

    Provide acceptable proof showing claim submission to Anthem within timely-filing limits

    Submit one or more of the acceptable proofs that demonstrate the claim was submitted to Anthem within the timely-filing limit, such as a clearinghouse report, Availity Level 2 Status Report, Anthem denial/RA/EOB, dated requests for information, computer-generated transaction or hard copy with correct Anthem address, or denial/RA/EOB from another insurer. Proof must include submission dates that are within the filing limits and show the claim was received and accepted (or include an Anthem letter or batch/error report verifying original EDI submission).

    • Clearinghouse report must show (a) the actual Anthem response, (b) a positive acceptance message, or (c) a facility/clearinghouse report objectively demonstrating submission to Anthem.
    • Level 2 Status Report from Availity must include submission dates within the filing limits and demonstrate the claim was submitted to Anthem.
    • Anthem denial letter/RA/EOB must show Anthem letter date, member information, dates of service, and demonstrate facility submission was within the filing limit.
    • For EDI claims, Anthem must indicate the original submission was within the filing limit or provide a batch number/error report to verify submission.
    • Computer-generated transactions or hard-copy documents must include the correct Anthem address and complete billing history to demonstrate submission.

    Definitions and Acceptable Documentation Types

    inv-03: Clearinghouse report / Electronic proof
    DefinitionClearinghouse report (electronic proof) must be from a clearinghouse and show one of: (a) the actual Anthem response to the electronic claim submission, (b) a positive acceptance message from Anthem, or (c) a facility/clearinghouse report objectively demonstrating the claim was submitted to Anthem.
    Required elementsSubmission dates must be included and be within the filing limits from the date of service (DOS).
    Verification stepsVerify that the claim was received and accepted for processing and confirm the submission date is within timely filing limits.
    Related evidenceFor EDI claims, include Anthem letter indicating original submission was within the filing limit or a batch number/error report to verify submission.
    inv-04: Level 2 Status Reports
    DefinitionLevel 2 Status Reports are generated by the Availity EDI Gateway and must demonstrate the claim was submitted to Anthem.
    Required elementsReports must include submission dates and those dates must fall within the timely filing limits from the date of service.
    Verification stepsConfirm the report shows the claim was received and accepted for processing and that submission date is within filing limits.
    inv-05: Anthem denial letter / RA / EOB
    DefinitionAnthem denial letter, Remittance Advice (RA) or Explanation of Benefits (EOB) showing Anthem letter date and verifying member information and dates of service.
    Required elementsThe Anthem letter/RA/EOB date must demonstrate that the facility's submission to Anthem was within the timely filing limit.
    Verification stepsUse the Anthem letter date to calculate timeliness from DOS; confirm member info and DOS match the claim submitted.
    inv-06: Other insurer denial / RA / EOB
    DefinitionDenial letter or RA/EOB from another insurer (other carrier) used as proof that the claim was submitted to that insurer.
    Required elementsLetter must be on valid letterhead, must be dated, and must demonstrate that submission to the other insurer occurred within Anthem's timely filing limits so timeliness to Anthem can be determined.
    Verification stepsEnsure the RA/EOB shows dates that allow calculation back to an Anthem submission within the filing limit.
    inv-07: Dated requests / patient billing history
    DefinitionDated requests for additional information or patient billing history may be acceptable proof when they document attempts to follow up on submission to Anthem.
    Required elementsDocuments must include dates, follow-up attempt dates, names and other pertinent details and show activity within the timely filing limit from DOS.
    Verification stepsConfirm follow-up attempts were made consistently within a reasonable time and that dates fall within the filing limitations from DOS to Anthem letter date.
    Related evidencePatient billing history should demonstrate follow-up attempts within the timely filing limit and include dates of those attempts.
    Policy Summary
    PayerBlue Cross Blue Shield - Wisconsin
    PolicyTimely Filing — Acceptable Forms of Proof
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionSubmit acceptable proof showing claim submission to Anthem within timely filing limits (clearinghouse reports, Availity Level 2 status, claim denial/RA/EOB, dated requests, computer-generated transactions, hard copy documentation, or proof of member billing).
    SourceLink
    On This Page
    Verification Criteria for Acceptable ProofWhat Providers Must SubmitDefinitions and Acceptable Documentation Types