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    OpenPayerPolicy UpdatesAdministrative/Operational PolicyHealthy Blue Louisiana Timely Filing Update | Open…
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    CurrentHealthy Blue LouisianaPolicy G-06133

    Proof of Timely Filing

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    This policy governs reconsideration of claims rejected for failure to meet timely filing requirements when providers submit evidence of timely claim receipt and good cause, subject to applicable provider, state, federal, or CMS requirements.

    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyProof of Timely Filing
    Policy CodePolicy G-06133
    Change TypeAdministrative evidence update
    Effective DateOct 23, 2025
    Next Review DateNot specified
    Key ActionSubmit evidence of a compliant claim receipt date and good cause when requesting reconsideration of a late-filed claim.
    SourceLink
    POLICY UPDATE CHANGES

    The policy was updated effective October 23, 2025 to accept Electronic Claims Status Inquiry (eCSI) screen prints as proof of timely filing.

    2Reconsideration conditions
    3Accepted receipt evidence types
    6Good-cause examples
    4Submission methods addressed

    Timely Filing Reconsideration Criteria

    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.

    Timely Filing Reconsideration Criteria

    The health plan will reconsider reimbursement of a claim that was not accepted because it failed timely filing requirements, unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise, when the provider demonstrates ALL of the following:

    ALL of the following

    • Provide a date of claim receipt that complies with applicable timely filing requirements.

      Proof of timely receipt may include electronic Claims Status Inquiry (eCSI) screen prints, a remittance advice, or correspondence by State or Parish.

    • Document claim receipt using the applicable requirements

      • For a claim submitted by fax, facsimile transmission is not considered proof that the claim was received timely.
      • For a claim submitted by hand delivery, provide a claim log identifying each claim included in the delivery and a copy of the signed receipt.
      • For a claim submitted by mail, provide an official mailing-service return receipt or delivery confirmation and a copy of the claim log identifying each claim included in the submission.
      • For a claim submitted electronically, provide the clearinghouse-assigned receipt date from the reconciliation reports.
      • Ensure the mailed claims log includes the claimant's name, address, telephone number, and federal tax identification number; name of addressee; name of carrier; designated address; date of mailing; subscriber name and ID number; member's name; dates of service or occurrence, total charge, and delivery method.
    • Demonstrate that good cause exists.

      If the claim includes an explanation for the delay or other evidence establishing the reason, the health plan will determine good cause primarily from that statement or evidence. If the evidence raises doubt about the statement's validity, the health plan will contact the provider for clarification or additional information needed to make the determination.

    Examples of Good Cause

    Good cause may be found when the provider's claim-filing delay was due to any of the following circumstances:

    ANY of the following

    • Administrative error: incorrect or incomplete information was furnished by official sources to the provider.
    • Retroactive enrollment: the member subsequently 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 health insurance plan, Original Medicare, or a State Medicaid plan.
    • Unavoidable delay in securing required supporting claim documentation or evidence from one or more third parties, despite the provider's reasonable efforts to secure the documentation or evidence.
    • Unusual, unavoidable, or other circumstances beyond the service provider's control that demonstrate the provider could not reasonably have been expected to know of the need to file timely.

    Coding Requirements

    Standard correct codingmixed
    No codes listed

    How to Request Reconsideration

    Documentation Required

    Request Reconsideration of a Late-Filed Claim

    Request reconsideration of a claim rejected for failure to meet timely filing requirements by submitting evidence that the claim was received within the applicable timely filing period. Reconsideration may also be requested when good cause explains the late filing, unless provider, state, federal, or CMS contracts or requirements provide otherwise.

    • Provide a claim receipt date compliant with applicable timely filing requirements.
    • Demonstrate that good cause exists when the claim was not timely filed.
    Documentation Required

    Submit Proof Based on Claim Delivery Method

    Submit documentation showing the claim was received within the period required by the Claims Timely Filing policy. Evidence may include electronic Claims Status Inquiry (eCSI) screen prints, a remittance advice, or correspondence from a state or parish.

    • Fax: A facsimile transmission is not accepted as proof of timely receipt.
    • Hand delivery: Provide a claim log identifying every claim included in the delivery and a copy of the signed receipt.
    • Mail: Provide official mailing-service return receipt or delivery confirmation, together with a copy of the claim log identifying every claim in the submission.
    • Electronic submission: Provide the clearinghouse-assigned receipt date from reconciliation reports.
    Documentation Required

    Maintain the Required Mailed-Claims Log

    Maintain a mailed-claims log for mailed submissions and retain a copy of the log with the supporting mailing evidence. The log must identify each claim included in the submission and document the required claimant, recipient, carrier, member, claim, and delivery information.

    • Claimant name, address, telephone number, and federal tax identification number
    • Addressee name, carrier name, and designated address
    • Date of mailing
    • Subscriber name and subscriber ID number
    • Member name
    • Date(s) of service or occurrence, total charge, and delivery method
    Documentation Required

    Support a Good-Cause Exception

    Support a good-cause exception with an explanation for the filing delay or other evidence establishing why the claim was late. The health plan will base its determination primarily on that statement or evidence and may request clarification or additional information if validity is in doubt.

    • Potential good-cause circumstances include administrative error, retroactive enrollment, incorrect member information, unavoidable delay obtaining third-party documentation despite reasonable efforts, unusual or unavoidable circumstances beyond the provider’s control, and destruction or damage of provider records not caused by the provider’s willful act or intentional oversight.
    Billing Rule

    Follow General Billing Requirements

    Follow applicable billing and submission guidelines and use industry-standard, compliant codes on every claim. CPT, HCPCS, and/or revenue codes must accurately represent the services or procedures performed and be fully supported by the medical record or office notes.

    • Services must also satisfy applicable authorization and medical-necessity requirements.
    • Failure to follow coding, billing, or submission requirements may result in claim rejection or denial, or recovery and recoupment of payment.
    • Provider, state, federal, or CMS contracts and requirements may supersede this policy.

    Policy Definitions

    General Reimbursement Policy Definitions
    Applicable definitionsGeneral reimbursement policy definitions apply.
    Policy applicationThese definitions apply to reimbursement review for claims rejected because timely filing requirements were not met.
    Review contextThe policy addresses documentation used to establish timely claim receipt and good cause when a claim is not accepted because of timely filing.
    Good Cause
    Primary basisGood cause is determined primarily from the provider's explanation for the delay or other evidence establishing the reason.
    Supporting circumstancesGood cause may be found for administrative error, retroactive enrollment, incorrect member information, difficulty obtaining required third-party documentation despite reasonable efforts, circumstances beyond the provider's control, or destruction or damage of provider records not caused by the provider's willful act or unintentional oversight.
    Clarification requestsIf the evidence creates doubt about the validity of the explanation, the health plan may contact the provider for clarification or additional information needed to make a good-cause determination.
    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyProof of Timely Filing
    Policy CodePolicy G-06133
    Change TypeAdministrative evidence update
    Effective DateOct 23, 2025
    Next Review DateNot specified
    Key ActionSubmit evidence of a compliant claim receipt date and good cause when requesting reconsideration of a late-filed claim.
    SourceLink
    On This Page
    Timely Filing Reconsideration CriteriaCoding RequirementsHow to Request ReconsiderationPolicy Definitions
  1. Destruction or other damage to the provider's records, unless the destruction or damage was caused by the provider's willful act of unintentional oversight.