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AETNA TIMELY FILING LIMIT 2018 HOW TO
AETNA TIMELY FILING LIMIT 2018 PROFESSIONAL
AETNA TIMELY FILING LIMIT 2018 FREE

An adverse initial utilization review decision.

A denial for non-inpatient hospital services that were denied for not receiving prior approval.

An adverse initial claim decision based on medical necessity or experimental/investigational coverage criteria.

Appeal:Īn appeal is a written request by a practitioner/organizational provider to change: Reconsideration:Ī reconsideration is a formal review of a previous claim reimbursement or coding decision, or a claim that requires reprocessing where the denial is not based on medical necessity or where outpatient services were denied for not receiving precertification. Dispute:Ī disagreement regarding a claim or utilization review decision.

Behavioral health organizations can be freestanding or hospital-based.

AETNA TIMELY FILING LIMIT 2018 FREE

Examples of organizational providers include, but are not limited to: hospitals, nursing homes, skilled nursing facilities (SNF), home care agencies, free standing surgical centers, birthing centers, urgent care centers, pain management centers, ambulance services, pharmacies, hospices, infusion centers, blood banks, diagnostic testing centers, diabetic treatment centers, residential treatment facilities, MRI centers, independent durable medical equipment vendors, orthotics facilities, oncology treatment centers, optical facilities and sleep diagnostic centers.īehavioral health organizations include, but are not limited to: mental health and chemical dependency hospitals, residential treatment facilities, partial hospital programs, intensive outpatient programs and clinics. Institutional providers and suppliers of health care services, including behavioral health care organizations. Examples include doctors, podiatrists and independent nurse practitioners. The following definitions apply in an insurance dispute: Practitioner:Īn individual who is licensed or otherwise authorized by the state to provide health care services. See our answers regarding the insurance dispute process Definitions It applies to all our medical benefits plans (please note that state requirements take precedence when they differ from our policy).

AETNA TIMELY FILING LIMIT 2018 HOW TO

The information below explains when and how to submit a dispute. If you have any questions, email our Network Relations staff at Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility.Health care professionals and organizational health care providers can dispute adverse decisions.

This means claims submitted on or after Octowill be subject to a ninety (90) day timely filing requirement, and Blue Cross will refuse payment if submitted more than ninety (90) days after the date of service1.

AETNA TIMELY FILING LIMIT 2018 PROFESSIONAL

Notification was sent June 21, 2019, to providers of applicable networks and contracts.Įffective for all claims received by Anthem on or after October 1, 2019, all impacted contracts will require the submission of all professional claims within ninety (90) days of the date of service. In the effort to simplify our processes, align with industry standards, and better support coordination of care, Anthem Blue Cross (Anthem) is changing professional agreements to adopt a common time frame for the submission of claims. Guideline Updates / Reimbursement Policies.