Author Topic: anthem medicare replacement denial, help!!!  (Read 1742 times)

sherry27

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anthem medicare replacement denial, help!!!
« on: June 10, 2010, 10:06:53 AM »
I am very confused. I thought medicare replacement plans have the same timely filing limits as medicare. I sent an old claim from september 2009 to anthem yre prefix, and it is denying for timely. I called insurance and they said I only have 6 months. I have never heard of this before. I explained that this is a medicare plan. Is anyone else familiar with this?
« Last Edit: June 10, 2010, 10:09:00 AM by sherry27 »

PMRNC

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Re: anthem medicare replacement denial, help!!!
« Reply #1 on: June 10, 2010, 11:34:01 AM »
No, they can have their own timely filing limit.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
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Pay_My_Claims

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Re: anthem medicare replacement denial, help!!!
« Reply #2 on: June 10, 2010, 01:41:25 PM »
Yup, Linda is correct, each plan is different and does have their own filing limits. I haven't seen one like Medicare, and probably will never.

PMRNC

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Re: anthem medicare replacement denial, help!!!
« Reply #3 on: June 10, 2010, 09:13:20 PM »
Yeah I have to agree, Medicare is the most generous I've seen with late filing.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

blhoffman

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Re: anthem medicare replacement denial, help!!!
« Reply #4 on: June 11, 2010, 01:26:56 PM »
Hi sherry27,

I can see how it can be confusing because I know many Medicare Advantage plans that do follow Medicare Timely filing guidelines BUT not all do. I would research to see if an appeal is valid in your case.

I worked four years as a claims processor/customer service/back end auditor/ for a Medicare Advantage plan and we covered seven states. We followed Medicare timely filing guidelines. See link below.
PA, OH, MO, IL, KS, DE, WV

http://www.altpho.org/art/RelatedSites/Advantra%20Freedom%20Quick%20Reference%20Guide.pdf

Also I found this on Empire Blue Cross/Blue Sheild Medicare Advantage Plan. They follow Medicare timely filing unless they specifically contract otherwise with a provider and if you are non-par then it is Medicare timely filing.

http://www.empireblue.com/provider/noapplication/f3/s3/t3/pw_b145580.pdf?refer=ehpprovider

Blue Cross/ Blue Sheild of Michigan Medicare Advantage plans also follow Medicare Timely filing guidelines.

http://www.bcbsm.com/newsletter/therecord/record_0610/record_0610z.shtml


Then there is GHC of Washington their Medicare Advantage follows Medicare Guidelines.

https://provider.ghc.org/open/render.jhtml?item=/open/billingAndClaims/claimsProcedures/claims-timely.xml


***NOTE***
Also see this link. Medicare has changed their timely filing guidelines for 2010.

http://www.allsupinc.com/changes-to-medicare-timely-filing-guidelines.aspx