CurrentWellpointPolicy G-06133

Reimbursement Policy Proof of Timely Filing

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Governs when Wellpoint Maryland may reconsider Medicaid claims rejected for untimely filing, including acceptable receipt documentation, good-cause exceptions, and claim-log requirements.

Policy Summary

PayerWellpoint

PolicyReimbursement Policy Proof of Timely Filing

Policy CodePolicy G-06133

Change TypeNo material change

Effective DateOct 23, 2025

Last ReviewOct 23, 2025

Next Review DateN/A

Key ActionProviders seeking reconsideration of an untimely claim must provide a compliant receipt date and demonstrate good cause for the delay.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Acceptable submission methods

1Unacceptable proof method

6Good-cause circumstances

13Mailed-claims log requirements

Reconsideration of Untimely Claims

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CurrentWellpointPolicy G-06133

Reimbursement Policy Proof of Timely Filing

Customize your policy alerts

Sign up for wellpoint Policy G-06133 alerts

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

Monitor payer policy activity

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Governs when Wellpoint Maryland may reconsider Medicaid claims rejected for untimely filing, including acceptable receipt documentation, good-cause exceptions, and claim-log requirements.

Policy Summary

PayerWellpoint

PolicyReimbursement Policy Proof of Timely Filing

Policy CodePolicy G-06133

Change TypeNo material change

Effective DateOct 23, 2025

Last ReviewOct 23, 2025

Next Review DateN/A

Key ActionProviders seeking reconsideration of an untimely claim must provide a compliant receipt date and demonstrate good cause for the delay.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Acceptable submission methods

1Unacceptable proof method

6Good-cause circumstances

13Mailed-claims log requirements

Reconsideration of Untimely Claims

Reconsideration of claims rejected for untimely filing

A claim rejected for failure to meet timely filing requirements may be reconsidered when the provider proves a compliant receipt date and demonstrates good cause, unless applicable provider, state, federal, or CMS contracts or requirements indicate otherwise.

ALL of the following

ALL of the following
- Provider supplies a date showing that claim receipt complied with applicable timely filing requirements.
- Provider demonstrates that good cause exists for the filing delay.
ONE of the following receipt-documentation methods
- For a mailed claim, provider supplies an official mailing-service return receipt or delivery confirmation and a claim log identifying each claim included in the submission.
- For an electronic claim, provider supplies the clearinghouse-assigned receipt date from reconciliation reports.
- For a hand-delivered claim, provider supplies a claim log identifying each claim included in the delivery and a copy of the signed receipt.

Good cause may be established when the filing delay resulted from ONE of the following

Administrative error involving incorrect or incomplete information furnished by official sources to the provider.
Retroactive enrollment, when the member subsequently received notification of enrollment effective retroactively to or before the date of service.
Incorrect information furnished by the member caused erroneous filing with another health insurance plan, Original Medicare, or a State Medicaid plan.
An unavoidable delay 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 that meant the provider could not reasonably have been expected to know that timely filing was required.

ALL of the following

Provider includes an explanation for the delay or other evidence establishing the reason for the delay.
If the evidence raises doubt about the validity of the explanation, provider supplies clarification or additional information requested by the health plan.

A fax or facsimile transmission is not considered proof that a claim was received timely.

Documentation for Timely Filing Reconsideration

Denial Risk

Request reconsideration of an untimely claim

To seek reconsideration of a claim rejected for untimely filing, provide a claim receipt date that complies with applicable timely filing requirements and demonstrate that good cause exists for the delay.

Documentation Required

Document mailed claim receipt

For a mailed claim, submit the official mailing-service return receipt or delivery confirmation and a copy of the claim log identifying each claim included in the submission.

Documentation Required

Document electronic claim receipt

For an electronically submitted claim, provide the clearinghouse-assigned receipt date from the reconciliation reports.

Documentation Required

Document hand-delivered claim receipt

For a hand-delivered claim, provide a claim log identifying each claim included in the delivery and a copy of the signed receipt.

Denial Risk

Fax is not acceptable proof

Do not rely on a fax or facsimile transmission as proof that a claim was received timely; facsimile transmission will not be considered proof of timely receipt.

Documentation Required

Establish good cause

Include an explanation for the filing delay or other evidence establishing the reason for the delay. If the evidence raises doubt about the statement’s validity, the health plan may request clarification or additional information.

Applicable Definitions

General Reimbursement Policy Definitions

Referenced definitionsGeneral Reimbursement Policy Definitions

Policy sectionDefinitions

UseRefer to the General Reimbursement Policy Definitions for applicable definitions.

Good Cause

Evaluation basisGood Cause is determined primarily from the provider's explanation or other evidence of the filing delay. If the evidence raises doubt about the statement's validity, the health plan may request clarification or additional information.

Administrative errorIncorrect or incomplete information furnished by official sources caused the delay.

Retroactive enrollmentThe member subsequently received notification of enrollment effective retroactively to or before the date of service.

Incorrect member informationIncorrect information furnished by the member resulted in erroneous filing with another health insurance plan, Original Medicare, or a State Medicaid plan.

Supporting documentation delayRequired supporting claim documentation or evidence was unavoidably delayed despite the provider's reasonable efforts to secure it from one or more third parties.

Circumstances beyond provider controlUnusual, unavoidable, or other circumstances beyond the service provider's control meant the provider could not reasonably have been expected to know that timely filing was required.

Damaged provider recordsProvider records were destroyed or otherwise damaged, unless the destruction or damage was caused by the provider's willful act or unintentional oversight.

Reimbursement Policy Proof of Timely Filing

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Reconsideration of Untimely Claims

Reimbursement Policy Proof of Timely Filing

Sign up for wellpoint Policy G-06133 alerts

Reconsideration of Untimely Claims

Standard Correct Coding

Documentation for Timely Filing Reconsideration

Applicable Definitions