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June 2013
Follow your filing limits; submit claims on time
Medicare Advantage claims must be filed within 1 year of service or discharge date
Please remember that, health care providers must file all BCBSM Medicare Advantage claims, including revisions or adjustments, within one calendar year of the service or discharge date. Claims filed after one calendar year of the date of service or discharge will be the health care provider’s liability, and providers may not balance bill the member.
We previously explained this requirement in a web-DENIS message posted Nov. 29, 2012. The information is also included in your Medicare Advantage PPO Provider Agreement.
You can access the BCBSM Medicare Advantage PPO Provider Agreement on our website.
Please remember: Beginning with 2013 service dates, BCBSM transitioned all Medicare Advantage claims processing to a new claims vendor. We encourage providers to submit claims with 2012 service dates as soon as possible to avoid any processing delays. We told you in the May 2013 issue of The Record that starting
May 24, 2013, filing limits will be strictly enforced.
If you submit a claim after your filing limits, 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. If you haven’t submitted a claim because you’re having difficulty identifying a member’s contract number, log in to web-DENIS and use the Subscriber Name Search feature.
Follow these guidelines:
- Deadline submissions for original claims remain the same – 180 days from the date of service for professional providers and 12 months from the date of service for facility providers.
- For secondary claims, status inquiries and adjustments, the deadline is within 24 months from the date of service.
- If you’re submitting a Master Medical claim that will be paid to the subscriber, the filing limit will be two years. Claims for dates of service prior to a contract migrating to the Michigan Operating System are pay-subscriber claims. After migration to MOS, the provider is paid, and regular filing limits apply.
Please note that 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.
For more information about this requirement, see the related article in the May 2013 issue of The Record or contact your provider consultant.
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