CurrentWellpointPolicy G-06133

Reimbursement Policy: Proof of Timely Filing

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This reimbursement policy governs when Wellpoint Washington Medicaid may reconsider a claim rejected for failure to meet timely filing requirements. It applies to providers submitting claims and requires evidence of timely receipt and, where applicable, documentation establishing good cause for the delay.

Policy Summary

PayerWellpoint Washington Medicaid

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 together with a claims log identifying each claim in the submission.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Accepted submission methods with specified proof

2Submission methods not accepted as proof

13Required mailed claims log elements

6Examples of circumstances that may establish good cause

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CurrentWellpointPolicy G-06133

Reimbursement Policy: Proof of Timely Filing

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Sign up for wellpoint Policy G-06133 alerts

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

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Policy Summary

PayerWellpoint Washington Medicaid

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 together with a claims log identifying each claim in the submission.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Accepted submission methods with specified proof

2Submission methods not accepted as proof

13Required mailed claims log elements

6Examples of circumstances that may establish good cause

No changesPolicy review outcome

Timely Filing Reconsideration Criteria

Reconsideration of claims rejected for untimely filing

A claim rejected for failure to meet timely filing requirements may be reconsidered when ALL of the following are met, unless applicable provider, state, federal, or CMS requirements provide otherwise:

ALL of the following

Proof of timely receipt through ONE of the following methods
- Mailed claim
  - Provide the official mailing-service return receipt or delivery confirmation.
  - Provide a claims log identifying each claim included in the submission.
- Electronic claim: Provide the clearinghouse-assigned receipt date from the reconciliation reports.
Demonstrate good cause for the filing delay through an explanation or other supporting evidence.

Insufficient proof of timely receipt

The following submission evidence is NOT accepted as proof that a claim was received timely:

ANY of the following

Facsimile transmission.
A hand-delivery claim log identifying each claim included in the delivery, together with a signed receipt.

Examples of good cause

Good cause may be found when the filing delay resulted from any of the following circumstances:

ANY of the following

Incorrect or incomplete information furnished by official sources to the provider.
The member was subsequently notified 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 occurred in securing required supporting claim documentation or evidence from one or more third parties, despite the provider's reasonable efforts to obtain it.
Unusual, unavoidable, or other circumstances beyond the provider's control made it unreasonable to expect the provider to have been aware of the need to file timely.

Coding Requirements

Standard correct codingmixed

No codes listed

Supporting a Reconsideration Request

Denial Risk

Support reconsideration of a late-filed claim

Request reconsideration of a claim rejected for failure to meet timely filing requirements by providing a claim receipt date compliant with applicable timely filing requirements and demonstrating that good cause exists, unless provider, state, federal, or CMS contracts or requirements indicate otherwise.

Documentation Required

Provide acceptable receipt evidence

Submit acceptable evidence showing the claim was received within the applicable timely filing period. Mailed claims require official mailing-service return receipt or delivery confirmation plus a claims log identifying each claim included in the submission; electronic claims require the clearinghouse-assigned receipt date from reconciliation reports.

Mailed claims: official mailing-service return receipt or delivery confirmation and a claim log identifying each included claim.
Electronic claims: clearinghouse-assigned receipt date from reconciliation reports.

Reimbursement Policy Definitions

General Reimbursement Policy Definitions

Governing referenceGeneral Reimbursement Policy Definitions

PolicyWellpoint Washington Medicaid Policy G-06133

Effective date2025-10-23

Good Cause

DefinitionGood Cause may be established when a claim includes an explanation for the delay or other evidence establishing the reason.

Primary evaluation basisThe health plan determines Good Cause primarily from the provider's statement or supporting evidence.

Verification

Policy Summary

PayerWellpoint Washington Medicaid

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 together with a claims log identifying each claim in the submission.

SourceLink

On This Page

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

Denial Risk

Avoid insufficient receipt evidence

Do not rely on facsimile transmission as proof that a claim was received timely. A hand-delivery claim log identifying each claim and a copy of the signed receipt will also not be considered proof of timely receipt.

Fax transmission is not accepted as proof of timely receipt.
Hand-delivery claim logs and signed receipts are not accepted as proof of timely receipt.

Documentation Required

Maintain the required mailed claims log

Maintain a mailed claims log with all information required to support proof of timely receipt.

Name, address, and telephone number of claimant
Claimant's federal tax identification number
Name of addressee
Name of carrier
Designated address
Date of mailing
Subscriber name and subscriber ID number
Member's name
Date(s) of service or occurrence
Total charge
Delivery method

Documentation Required

Document good cause for filing delay

For a delayed claim, provide an explanation for the delay or other evidence establishing the reason. Good cause is determined primarily from that statement or evidence; if its validity is in doubt, be prepared to provide clarification or additional information requested by the health plan.

Good cause may involve administrative error, retroactive enrollment, incorrect member information, unavoidable third-party documentation delays 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.

If the evidence raises doubt about the validity of the statement, the health plan will contact the provider for clarification or additional information.

Examples of qualifying circumstancesExamples include administrative error, retroactive enrollment, incorrect member information, unavoidable third-party documentation delays, circumstances beyond the provider's control, and destruction or damage of provider records unless caused by the provider's willful act or unintentional oversight.