Anthem has notified doctors and other providers that the timely filing window for professional claims is being shortened to 90 days.
“Effective for all commercial and Medicare Advantage Professional Claims submitted to the plan on or after Oct. 1, 2019, your Anthem Blue Cross and Blue Shield (Anthem) Provider Agreement(s) will be amended to require the submission of all commercial and Medicare Advantage professional claims within ninety (90) days of the date of service. This means all claims submitted on or after October 1, 2019 will be subject to a ninety (90) day timely filing requirement,” states the announcement.
The notice also hints at the possibility of negotiating the time frame but makes it clear they are prepared to lose some contracted providers over the amendment. The wording is as follows:
“If you object to the enclosed amendment, you must provide us with written notice of your appeal within 30 days of receipt of this letter. If, after 30 days, we are unable to reach an agreement, your contract will terminate on or before October 1, 2019.”
The amendment could increase lack of timely filing denials for many offices. Those practices who anticipate denials should initiate discussion with Anthem over the amendment. However, prior to initiating negotiation, it might be helpful to gather basic information regarding Anthem’s claim processing performance. Some of the variables that might impact your timely filing including the following:
Claim acknowledgment/error reporting process – do you get immediate acknowledgment that an Anthem claim was successfully filed with the insurer.
Does Anthem provide error reporting on claims which are not successfully filed with sufficient detail to allow you to correct any rejected claims.
Further, your internal process may need to be assessed to make sure that claims can be generated within the tighter filing deadline. Review the following variables that may impact prompt claim filing internally:
Delayed claim detail (administrative and clinical) – Do you have claim scenarios that frequently involve delayed claim detail?
Poor internal claim submission tracking and follow up features
Now is the time to identify internal claim processing bottleneck and get the claims submission engine running efficiently.