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April 2013

Reminder: Claims must be submitted by filing limits

We will systematically enforce claims filing limits, effective May 24, 2013.

If you submit a claim after your filing limit, Blue Cross Blue Shield of Michigan will not offer any special handling or filing extensions, and no payment will be due from BCBSM or the subscriber.

We’ve reminded you since April 2012 that it’s imperative that you submit your claims on time. As we continue to improve and enhance our claims processing operations, it’s critical that you follow submission deadlines for all claims.

Deadline submissions for original claims remain the same – 180 days for professional health care providers and 12 months from the date of service for facility providers. All health care providers must also submit secondary claims, status inquiries and adjustments within 24 months of the date of service.

Note: Secondary, tertiary, dental and all pay-subscriber claims for Federal Employee Program® members must be submitted by Dec. 31 of the year following the original date of service.

Check your BCBSM participation agreement, which defines your time periods for filing claims.

For more information about this requirement, contact your provider consultant.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.