Oct. 28, 2024
As a participating provider, you’ve agreed to submit claims to us in a timely manner prior to seeking payment from our members for any deductible or coinsurance amount.
Why it’s important: Claim submission requirements ensure your claims can be processed and paid promptly for covered services rendered according to details of the member’s benefit plan.
What this means to you: Claims received after the timely filing deadline will be denied for payment. When this happens, you may not seek reimbursement from the member for the amounts not paid due to non-compliance with timely filing requirements.
Details: Timely filing requirements are included in our provider manuals. A summary is included below, as a reminder. For more details, refer to the provider manuals on our website.
Commercial non-HMO claims: Professional PPO, Blue Choice PPOSM and Blue High Performance Network® participating providers must submit claims within the 180-day period following:
The date of discharge or transfer for inpatient health services and/or the date of service for all other health services that are not inpatient; or
The date of the participating provider’s receipt of the explanation of benefits from the primary payer when Blue Cross and Blue Shield of Illinois is the secondary payer.
For more information on professional claims, timely filing requirements for facility claims and HMO claim filing information, refer to the Billing and Reimbursement and HMO Claims Processing sections of the commercial provider manual. Some employer groups have different time frames for filing claims. If you have questions, call the number on the member’s ID card.
Medicare and Medicaid claims: In general, participating providers are required to submit claims within 180 days of the service or discharge date for covered services provided to Blue Cross Community Health PlansSM, Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare AdvantageSM members.
For more information, refer to the provider manuals for BCCHPSM, MMAI and Medicare Advantage.
Questions? Our Provider Network Consultant team is your liaison with BCBSIL. Among other services, your PNC can help with adherence to financial requirements and contractual compliance. Refer to the PNC Assignments page for details and contact information.