CurrentWellpointPolicy G-06133

Proof of Timely Filing

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Governs reconsideration of Medicare Advantage claims rejected for untimely filing, including acceptable proof of receipt and circumstances that may establish good cause.

Policy Summary

PayerWellpoint

PolicyProof of Timely Filing

Policy CodePolicy G-06133

Change TypeNo material changes

Effective DateOct 23, 2025

Last ReviewOct 23, 2025

Next Review DateNot specified

Key ActionRequest reconsideration only when you can provide a compliant claim receipt date and demonstrate good cause.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Required elements for reconsideration

2Accepted submission methods

2Unaccepted proof methods

12Mailed claims log data elements

6Good-cause examples

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CurrentWellpointPolicy G-06133

Proof of Timely Filing

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

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Governs reconsideration of Medicare Advantage claims rejected for untimely filing, including acceptable proof of receipt and circumstances that may establish good cause.

Policy Summary

PayerWellpoint

PolicyProof of Timely Filing

Policy CodePolicy G-06133

Change TypeNo material changes

Effective DateOct 23, 2025

Last ReviewOct 23, 2025

Next Review DateNot specified

Key ActionRequest reconsideration only when you can provide a compliant claim receipt date and demonstrate good cause.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Required elements for reconsideration

2Accepted submission methods

2Unaccepted proof methods

12Mailed claims log data elements

6Good-cause examples

Conditions for Reconsideration

Conditions for reconsideration

A claim rejected for failure to meet timely filing requirements may be reconsidered when both conditions are met, unless applicable provider, state, federal, or CMS contracts or requirements indicate otherwise.

ALL of the following

ALL of the following
- Provide a claim receipt date compliant with applicable timely filing requirements.
- Demonstrate that good cause exists for the delayed filing.

Acceptable proof and good cause

Supporting documentation must establish timely receipt or support a good-cause determination.

ONE of

For a mailed claim, 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 an electronically submitted claim, provide the clearinghouse-assigned receipt date from reconciliation reports.
Provide an explanation or other evidence supporting good cause for the filing delay.

Standard Correct Coding

Standard correct codingmixed

No codes listed

Reconsideration Submission Requirements

Documentation Required

Requirements for Reconsideration

When a claim is rejected for failure to meet timely filing requirements, the provider may request reconsideration. Reimbursement will be reconsidered unless applicable provider, state, federal, or CMS contracts or requirements indicate otherwise, when the provider supplies a compliant claim-receipt date and demonstrates good cause.

Provide a date showing the claim was received within the applicable timely filing period.
Demonstrate that good cause exists for the delayed filing.

Documentation Required

Proof for Mailed Claims

For a claim submitted by mail, provide official mailing-service proof showing delivery or receipt, together with the provider's claim log identifying every claim included in the submission.

Official mailing-service return receipt or delivery confirmation.
A copy of the claim log identifying each claim included in the mailing.

Related Definitions

General Reimbursement Policy Definitions

Definitions resourceGeneral Reimbursement Policy Definitions

Policy contentThis policy does not provide individual definitions.

Reader directionRefer to General Reimbursement Policy Definitions for applicable terminology.

Documentation Required

Mailed Claims Log Requirements

The provider-maintained log for mailed claims must contain all required claimant, addressee, carrier, mailing, subscriber, member, service, charge, and delivery details.

Claimant: name, address, telephone number, and federal tax identification number.
Mailing details: name of addressee, name of carrier, designated address, date of mailing, and delivery method.
Claim and member details: subscriber name, subscriber ID number, member's name, and date(s) of service or occurrence.
Total charge.

Documentation Required

Good Cause Documentation

Include an explanation of the filing delay or other evidence establishing its reason. The health plan will base its good-cause determination primarily on that statement or evidence and may contact the provider for clarification or additional information if the evidence raises doubt about the statement's validity.

Submit the explanation or supporting evidence with the reconsideration request.
Respond to requests for clarification or additional information needed to determine good cause.

Note

Examples of Good Cause

Good cause may be found when the provider's claim-filing delay resulted from circumstances that prevented reasonably timely filing.

Administrative error, including incorrect or incomplete information furnished by official sources to the provider.
Retroactive enrollment, when the member later receives notice of enrollment effective retroactively to or before the date of service.
Incorrect information furnished by the member that led to 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.
Unusual, unavoidable, or other circumstances beyond the provider's control showing the provider could not reasonably have been expected to know that timely filing was required.
Destruction of or other damage to the provider's records, unless caused by the provider's willful act or unintentional oversight.