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Why and When Claim Delay Letters Are Sent

We realize that with the recent claims inventory issues we’ve experienced that many of you are receiving more letters than usual from us indicating that there is a delay with the processing of the claim in question. As we continue to work diligently to reduce our claims inventory, we would like to remind you about why such letters are sent out. 

Why?

As required by the North Carolina Prompt Pay law, all payers are required to send notification to providers when there is any delay in the processing of a claim. These letters advising you of claims processing delays are informational only. They have no impact on Blue Cross and Blue Shield of North Carolina (BCBSNC) paying you any applicable prompt pay interest that is due in accordance with North Carolina General Statute (NCGS) §58-3-225.   

When?

These letters are mailed out whenever a claim remains open and reaches the following age(s) in our claims processing system of 30, 60, 90, 120 and 150 days. 

If a claim is still open in our system and we have not determined if it is a true duplicate, any duplicate claim submitted will be treated like any other claim waiting to be processed; i.e., a letter indicating a delay in the processing of the claim will be sent for duplicate submissions too. 

Also, effective January 1, 2014, the Affordable Care Act requires insurers to provide a three-month grace period for individuals enrolled through exchanges who also receive federal health subsidies and who have paid their share of at least one month of premiums due. If we are unable to pay a claim due to premium delinquency on the part of the member, you will receive a letter each time a claim is received for that member during the second and third months of the grace period. 

How to Reduce the Volume of Letters Received

In order for us to continue to move forward in improving our claims processing cycle times, please do not submit duplicate claims, as they increase our inventory and impact our timeliness in processing your claims.

In order to better assist you, we have created an escalation process to address your concerns about aged claims. If you have outstanding claims greater than 60 days, and you've not already spoken to one of our provider specialists, please call us at 1-800-214-4844 for assistance.