Timely Filing Limit

Policy Number: GP-X-046

Last Updated: Dec. 8, 2022 

Providers are contractually responsible for filing clean claims within 120 days 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 or the timeframe specified in the applicable provider agreement.  

For adjustments or revisions, providers will be held to the post-service adjustment timely filing deadline of 12 months from the latest payment, or the specific language specified in their contract.  

When Blue Cross and Blue Shield of Nebraska (BCBSNE) is the secondary payor, claims must be received 120 days after 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 claims are subject to the timely filing limits of the member’s plan.  

Exceptions to the timely filing rule can apply to:

  • Coordination of benefits (timely filing is 120 days from the date on the primary payor’s EOB, which must be included)  
  • Subrogation – timely filing limit in the provider’s contract applies. The exception is to the adjustments/revision rule (above). Timely filing requirement starts on the date of care.  
  • Worker’s compensation (timely filing is 120 days from the date on the worker’s compensation carrier letter, which must be included) 
  • 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 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.

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 the money collected.