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Anthem issues caution about timely claim filing limit
The ISMA has received phone calls from medical offices regarding denials by Anthem for untimely filing of claims.
Upon contacting Anthem representatives, the ISMA learned the insurer published a notice in an Anthem newsletter in January. It reminded physicians and other providers to make certain they are in compliance with terms of their contracts when filing claims.
Anthem sent the ISMA the following clarification on the issue:
“The Anthem professional provider agreement provider manual section VI addresses the submissions of claims requirement being 90 days from the date of service. While Anthem may not have always enforced it, the requirement was 90 days. In the first issue of our provider newsletter of 2007, we published an article on page 11 notifying providers of the timely filing requirement. We have implemented it, however, allowing for 180 days instead of the 90 days as the contract states.”
“Offices should review all their contracts for claim filing limits, which can vary by payer and by plan,” said Julie Reed, J.D., ISMA legal counsel. “A payer may choose, as in this case, to relax the terms you agreed to, but those terms may still be enforceable. So it is good practice to always make sure you are complying with the contract terms in the event they are enforced.”
If you have questions regarding compliance with Anthem’s contract terms, contact Jeri Biedenkopf, R.N., at the ISMA.
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