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Two-year filing limit for corrected claims

Release Date: November 1, 2012

(Applicable to BCBSNC commercial products and the North Carolina State Health Plan)

Blue Cross and Blue Shield of North Carolina (BCBSNC) will be implementing a new two-year (24- month) time limitation for the submission of corrected claims and adjustments beginning January 1, 2013 to align with the North Carolina Prompt Pay law. This is a change from our current process that will allow for a corrected claim to be filed to BCBSNC for additional review, up to 36-months following the date that a claim was originally processed by BCBSNC. 

As an example: 

A claim originally processed by BCBSNC on May 3, 2012, could be eligible for additional review as a corrected claim or adjusted claim, providing BCBSNC is in receipt of the corrected claim no later than May 3, 2014.  Additionally, a corrected claim received by BCBSNC on May 4, 2014 or after, would be ineligible for additional payment review. 

The two-year filing allowance for corrected claims does not replace BCBSNC’s current 180-day filing requirement for the submission of new claims.  All first-time claims must be filed according to BCBSNC’s filing guidelines in order to be eligible for any future reviews as corrected or adjusted claims. 

BCBSNC’s Medicare Advantage plans, the Federal Employee Program (FEP), and the State Health Plan (SHP) have timely filing requirements for the submission of claims, which can differ from guidelines for BCBSNC’s commercial plans.  Therefore, we’ve provided the below chart explaining timely filing guidelines for both original and corrected claims.

Claim submission time guidelines

 

Original Claims

Corrected Claims

BCBSNC Commercial Lines of Business

Claims for professional and facility services must be submitted within 180- days from which services were rendered or the date of discharge

Corrected claims must be submitted within 2-years/24-months from when the original claim was processed by BCBSNC

Medicare Advantage

Claims for professional and facility services must be submitted within 180- days from which services were rendered or the date of discharge

Corrected claims must be submitted no later than 1-year/12-months from the date of service

 

Unless qualifying as an eligible exception under guidance of the Centers for Medicare and Medicaid Services (CMS)

FEP

Claims for professional and facility services must be submitted by December 31st of the calendar year, following the year in which the services were rendered or the date of discharge

Corrected claims must be submitted within 3-years/36-months from when the original claim was processed by BCBSNC

SHP

Claims for professional and facility services must be submitted within 18-months from which the services were rendered or from the date of discharge

Corrected claims must be submitted within 2-years/24-months from when the original claim was processed by BCBSNC

BCBSNC defines a corrected claim as any claim for which you have received a Notification of Payment (NOP) or Explanation of Payment (EOP), and for which you need to make corrections to the original claim submission. Corrections can be additions (e.g., late charges), a replacement of the original claim, or a cancellation of the previously submitted claim. 

Before sending a corrected claim to BCBSNC please consider the following:

-      The corrected claim replaces the original claim; you must submit all charges that were on the original claim if you want them to remain.  Do not send just the line item or charge that has changed.

-      Corrected claims can be submitted electronically through Blue e, on a paper CMS-1500 or a UB-04 claim form.

-      The words “Corrected Claim” must be written or stamped on the top of the claim form if filing a corrected claim on paper.

-      When filing a corrected claim using a UB-04 facility claim form, you must also change the bill type in form locator four (4) to reflect the claim has been corrected. 

If a claim has been mailed back, it is no longer in BCBSNC’s claims processing systems and must be resubmitted as a new claim within 180-days of the original date of service (additional filing time is allowed if filing for SHP or FEP).

Providers with questions regarding BCBSNC’s implementation of this two-year filing requirement for submission of corrected claims should contact the Provider Blue Line at 1.800.214.4844 or contact their designated regional Strategic Provider Relations representative. 

This notice shall be deemed to be a part of the Blue Book Provider eManual effective January 1, 2013.