Timely Claims Filing
The following guidelines for timely submission of
claims apply to all types of participating providers
and hospitals across all lines of business including
government programs, except the Federal Employee Program
(FEP).
- Original claims must be submitted within 12 months from the date of service in order to be processed.
- Any adjustments to the original claim must be submitted within 12 months, or 24 months for claims that include coordination of benefits (COB) from the original process date.
NOTE: For Medicare patients, including Regence MedAdvantage, original claims must be submitted within 12 months from the date of service and adjustments to the original claim must be submitted within 12 months from the original process date, whether or not you are a participating provider, in accordance with Medicare guidelines.
There might be times where an exception to the above
guidelines may apply (e.g., Coordination of Benefits
related claim, adjustments, etc.). Submission of documentation
for proof of a timely filing exception is required.
A timely filing exception is not considered a Provider
Appeal.
If you have questions about a timely filing denial,
please contact the appropriate customer
service department.
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