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June 2017

BlueCard® connection: Why can’t I bill the patient when a claim rejects for timely filing?

As we mentioned in our March 2017 “BlueCard connection” article, providers should be aware of two filing limits with BlueCard claims:

  1. There’s a timely filing limit imposed by Blue Cross Blue Shield of Michigan based on your contractual requirements.

  2. The member’s home plan could have a timely filing limit related to his or her contracted group benefits.

When claims reject for timely filing, the charges are a provider’s liability and require provider write-off. We understand that sometime things occur that are outside of a provider’s control. So if you disagree with a timely filing rejection, you may contact Provider Inquiry for assistance. A representative will work with you to review the rejection and take corrective action when appropriate.

To ensure that your BlueCard claim is processed within the timely filing limits:

  • Familiarize yourself with your timely filing requirements per your contract with Blue Cross.
  • Verify whether a member’s contract has timely filing restrictions when verifying eligibility and benefits.
  • File claims promptly.

For more information on the BlueCard program, including links and articles on online tools, reference the BlueCard chapter of the online provider manuals.

If you’re experiencing issues with the information provided in the BlueCard chapter of the online manual — or if you’d like more information on a particular topic — contact your provider consultant.

Want to suggest a topic to be covered in this series? Send an email to ProvComm@bcbsm.com and put “BlueCard series” in the subject line.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2016 American Medical Association. All rights reserved.

 

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