Timely Filing Limit

Providers are contractually responsible for filing clean claims within 120 days of the date of service or the timeframe specified in the applicable provider agreement. 
 
If a claim submission is rejected or returned (unprocessed) due to incorrect or invalid information, it is the provider’s responsibility to make the necessary corrections and resubmit the claim within 120 days of the date of service or the timeframe specified in the applicable 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 the specific language specified in the provider contract. 
 
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. 

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/or exceptions are subject to the timely filing limits of the member’s Plan.

Exceptions to the timely filing rule can apply to:

• Obstetrical (OB) claim, total OB care 
• Fraud, waste, abuse or intentional misconduct 
• Not obtaining member identification card – For exception consideration, providers must produce written documentation, obtained at the time of service and signed by the member, indicating that the member does not have insurance. Proof of attempts to obtain insurance information from the member within the timely filing period will be considered at the discretion of BCBSNE. Documentation must be submitted to BCBSNE within 12 months of the date of service.

BCBSNE does not consider a rejected or returned claim as proof of timely filing.

If other carrier information needs to be reviewed, please use the Reconsideration Form. This should be submitted via NaviNet^® for the following requests:

• Coordination of benefits (timely filing is 120 days from the date on the primary payor’s EOB or the notice from a credit balance recovery company advising of a future recoupment, which must be included) 
• Worker’s compensation (timely filing is 120 days from the date on the worker’s compensation carrier letter, which must be included)

Please 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.

• Please include the page from the clearinghouse report showing both the clearinghouse and BCBSNE accepted the claim without errors (this must be included, or the request will not be considered).
• 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. 
• These requests will not be considered. 

Please use the Timely Filing Override Request Form to submit your request for an override. You may submit the request via NaviNet or via email to ProviderExecs@NebraskaBlue.com. Claims submitted and processed under an incorrect patient and/or member ID number will need to be voided and a new claim submitted before the timely filing deadline. 
 
If a claim is denied as timely and you collected any payment from the member at the time of service (deductible, coinsurance, copay) you must refund to the member the money collected. 

_{NaviNet^® is a healthcare provider portal providing services for Blue Cross and Blue Shield of Nebraska.}