Timely Filing Limit

Providers are contractually responsible for filing clean claims within 120 days of the date of service or the time frame specified in the applicable provider agreement.

Rejected or returned claims:

• If a claim is rejected or returned due to incorrect information, providers must correct and resubmit it within 120 days of the date of service or as specified in the provider agreement.
• No adjustments or revisions to timely filed claims will be accepted more than 12 months from the last date of adjudication by Blue Cross and Blue Shield of Nebraska (BCBSNE) or as specified in the provider contract.

Secondary payor claims:

• When BCBSNE is the secondary payor, claims must be received within 120 days from the date the provider receives the Explanation of Benefits (EOB) from the primary payor, this excludes Medicaid, BCBSNE is never secondary to Medicaid and coordination of benefits does not apply.
• Claims denied due to exceeding the timely filing limit are the provider’s liability and cannot be billed to the member.
• The Federal Employee Program (FEP) follows the same timely filing limits.
• Non-Nebraska Blue Cross and Blue Shield member claim adjustments and exceptions are subject to the timely filing limits of the member’s Plan.

Exceptions to timely filing:

• Antepartum global charges
• Obstetrical (OB) claims, total OB care.
• Fraud, waste, abuse or intentional misconduct.
• Not obtaining member identification card:
  • If a member does not have their insurance card at the time of service or the member presents with Medicaid as their only insurance, providers must:
    • Obtain and submit written documentation signed by the member at the time of service, stating they do not have insurance.
    • Provide proof of attempts to get insurance information from the member within the timely filing period.
    • BCBSNE will review these exceptions at their discretion. All documentation must be submitted within 12 months of the service date.
• For Medicaid:
  
  • Providers must submit the claim to BCBSNE as soon as they learn that the member has BCBSNE insurance. If the claim is beyond the timely filing limits, providers must wait for the denial and then submit a timely filing override request, including proof of the Medicaid recoupment.

Timely filing override requests submissions:

• Use the electronic Timely Filing Override Request Form available in NaviNet^® to submit your request for an override. Requests are not accepted via US mail, email or fax.
• Claims submitted and processed under an incorrect patient and/or member ID number must be voided and a new claim submitted before the timely filing deadline.

Other carrier information – NOT a timely filing exception:

• Use the Reconsideration Form via NaviNet for:
  • Coordination of benefits (claims must be submitted 120 days from the date on the primary payor’s EOB or notice from a credit balance recovery company advising of a future recoupment).
  • Worker’s compensation (claims must be filed 120 days from the date on the worker’s compensation carrier letter).
• Do not submit medical records unless specifically requested by BCBSNE.
• If a claim is listed on a BCBSNE-accepted claim report and shows no errors but was not processed or returned, we will reconsider the timely filing rejection and process the claim. Include the page from the clearinghouse report clearly indicating both the clearinghouse and BCBSNE accepted the claim without errors.
• Returned claims cannot be used as proof of timely filing of a clean claim.
• BCBSNE does not consider provider internal delays as a reason to override timely filing.

Refunds:

• If a claim is denied as untimely and you collected any payment from the member at the time of service (deductible, coinsurance, copay), you must refund the money collected to the member.

_{NaviNet^® is a healthcare provider portal providing services for Blue Cross and Blue Shield of Nebraska, an independent licensee of the Blue Cross Blue Shield Association.}