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September 2013

Adhere to your filing limits and submit claims on time

We’ve been telling you that we’re strictly enforcing claims filing limits, as of May 24, 2013.

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 and status inquiries, the deadline is 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.

For more information, 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
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