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    v1.0.31
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyHealthy Blue LA Timely Filing Policy Update | Open…
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    CurrentHealthy Blue LouisianaPolicy G-06133

    Proof of Timely Filing

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    Administrative reimbursement rules for reconsidering claims rejected for untimely filing when providers provide compliant receipt evidence and establish good cause.

    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyProof of Timely Filing
    Policy CodePolicy G-06133
    Change TypeNo material change
    Effective DateOct 23, 2025
    Last ReviewOct 23, 2025
    Next Review DateNot specified
    Key ActionFor mailed claims, submit an official mailing-service return receipt or delivery confirmation and a claim log identifying each claim.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2Accepted proof methods
    2Methods not accepted as proof
    6Good-cause circumstances
    13Mailed claim log requirements

    Reconsideration Eligibility

    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.

    Reconsideration of untimely claims

    A claim rejected for failure to meet timely filing requirements may be reconsidered when the provider meets all of the following, unless applicable provider, state, federal, or CMS requirements indicate otherwise.

    ALL of the following

    • The provider demonstrates a claim receipt date compliant with applicable timely filing requirements.

    • Acceptable proof depends on the submission method.

      • ALL of the following

        • For mailed claims, provide an official mailing-service return receipt or delivery confirmation.
        • Provide a copy of the claim log identifying each claim included in the submission.

          The mailed claims log must include the claimant's name, address, telephone number, federal tax identification number, addressee, carrier, designated address, date of mailing, subscriber name and ID number, member name, date(s) of service or occurrence, total charge, and delivery method.

      • For electronic claims, provide the clearinghouse-assigned receipt date from reconciliation reports.

    Good-cause criteria

    Good cause may be established through an explanation or other evidence showing that the filing delay resulted from a recognized circumstance.

    The provider must establish good cause for the filing delay.

    • Administrative error involving incorrect or incomplete information furnished by official sources to the provider.
    • Retroactive member enrollment effective on or before the date of service.
    • Incorrect information furnished by the member caused erroneous filing with another health insurance plan, Original Medicare, or State Medicaid plan.
    • An unavoidable delay occurred in securing required supporting claim documentation or evidence from one or more third parties, despite the provider's reasonable efforts to secure it.
    • Unusual, unavoidable, or other circumstances beyond the provider's control prevented the provider from reasonably being expected to know of the need to file timely.

    Standard Coding

    Standard Codingmixed
    No codes listed

    Submission Requirements

    Billing Rule

    Requirements for Reconsideration

    To request reconsideration of a claim rejected for untimely filing, the provider must meet applicable contract, state, federal, and/or CMS requirements and demonstrate both a timely claim receipt date and good cause for the filing delay.

    • Provide a date the claim was received that complies with the applicable timely filing requirements.
    • Demonstrate that good cause exists for the delay.
    Documentation Required

    Submit Acceptable Proof of Claim Receipt

    Submit acceptable evidence showing the claim was received within the timely filing period. Proof must include the required receipt evidence and, for mailed claims, a complete claim log with the information listed below.

    • Mailed claims: Provide an official mailing-service return receipt or delivery confirmation, plus a copy of the claim log identifying each claim included in the submission.
    • Electronic claims: Provide the clearinghouse-assigned receipt date from reconciliation reports.
    • Not accepted as timely-receipt proof: Fax transmission; or, for hand delivery, a claim log identifying each claim and a copy of the signed receipt.
    • Mailed claim log requirements: Include the claimant's name, address, telephone number, and federal tax identification number; addressee name; carrier name; designated address; mailing date; subscriber name and ID number; member name; dates of service or occurrence; total charge; and delivery method.
    Note

    Establish Good Cause

    Provide an explanation for the filing delay or other supporting evidence establishing the reason for the delay. The health plan will base its Good Cause determination primarily on that submission and may contact the provider for clarification or additional information if the evidence raises doubt about the statement's validity.

    • Good Cause may apply when the delay resulted from administrative error, including incorrect or incomplete information from official sources.
    • Good Cause may apply when the member was retroactively enrolled effective on or before the date of service.
    • Good Cause may apply when incorrect member information caused erroneous filing with another health plan, Original Medicare, or State Medicaid.
    • Good Cause may apply when required supporting documentation or evidence from a third party could not be secured despite the provider's reasonable efforts.
    • Good Cause may apply for unusual, unavoidable, or other circumstances beyond the provider's control when the provider could not reasonably have been expected to know that timely filing was required.
    • Good Cause may apply when provider records were destroyed or otherwise damaged, unless caused by the provider's willful act or unintentional oversight.

    Applicable Definitions

    General Reimbursement Policy Definitions
    Applicable definitionsRefer to the General Reimbursement Policy Definitions for applicable definitions.
    Policy referenceGeneral Reimbursement Policy Definitions
    UseUse the referenced definitions when applying this reimbursement policy.
    Good Cause
    DefinitionGood Cause may be established when a provider explains the filing delay or provides other evidence establishing the reason for the delay.
    Determination basisThe health plan determines Good Cause primarily from the provider's statement or supporting evidence.
    Clarification requestsIf the evidence creates doubt about the statement's validity, the health plan may contact the provider for clarification or additional information needed to make the determination.
    Recognized circumstancesGood Cause may include administrative error, retroactive enrollment, incorrect member information, unavoidable delays obtaining 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.
    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyProof of Timely Filing
    Policy CodePolicy G-06133
    Change TypeNo material change
    Effective DateOct 23, 2025
    Last ReviewOct 23, 2025
    Next Review DateNot specified
    Key ActionFor mailed claims, submit an official mailing-service return receipt or delivery confirmation and a claim log identifying each claim.
    SourceLink
    On This Page
    Reconsideration EligibilityStandard CodingSubmission RequirementsApplicable Definitions
  1. Destruction or other damage to the provider's records occurred, unless the destruction or damage was caused by the provider's willful act or unintentional oversight.