tracelogoRBTime is money...

 

HNS/Payor Timely Filing Policies 

 

HNS Policies and "Best Practices" improve cash flow, reduce A/R, and reduce timely filing denials.

 

HNS Timely Filing Policies

  1. All primary claims must be filed to HNS within 15 days of the date of service.
  2. All secondary claims must be filed to HNS within 15 days of the date of receipt of the primary EOB.
  3. All corrected claims must be filed to HNS within 15 days of the date of receipt of the EOB for the original claim.

 

HNS Best Practices

 

HNS has developed best practices to reduce timely filing denials.  The consistent utilization of the following best practices will improve your cash flow, reduce your A/R, and should eliminate timely filing denials.

  1. Consistently comply with HNS and payor Timely Filing Policies.
  2. Always obtain and document timely filing policies when verifying benefits for each patient, as these vary among payors.
  3. Ensure all primary claims are submitted via HNSConnect (or, as applicable, Office Ally).  

    Exceptions:

    • If HNSConnect indicates the initial claim has an error, the claim may need to be submitted by paper.

      Note:  If a change to the member's ID number or DOB is required, the claim should be resubmitted via HNSConnect.

    • Certain CIGNA TPA claims must be sent to HNS via paper claims.  Please refer to the CIGNA Quick Reference Guide on the HNS website for a list of those TPAs.
  4. Promptly research and resolve issues associated with HNS Electronic Claim Error Reports and promptly refile those claims.
  5. Within 24 hours of submission of a claim filed via HNSConnect, check the status of the claim file to ensure no claims errored back to you.  If a claim has an error, promptly correct and resubmit the claim, then follow up the next day to ensure the revised claim was accepted by HNSConnect.

    Note: If the error is due to an incorrect member ID number OR incorrect DOB, correct the information and resubmit the claim via HNSConnect.

  6. Ensure you and your staff understand what a "corrected" claim is and mark it as corrected ONLY if it meets the criteria of a corrected claim.  A corrected claim should ONLY be filed when you have received the EOB, and a change is required relative to the information included on the originally submitted claim.  Corrected claims are mailed by HNS to the payors, therefore proof of timely filing cannot be provided.
  7. Ensure you and your staff only submit an attachment to a paper claim when the attachment is required in order for the claim to be adjudicated.  Claims with attachments must be mailed by HNS to the payors; therefore, proof of timely filing cannot be provided.
  8. Most importantly, generate an aging report each month, promptly investigate, and take appropriate follow up action regarding any claims with dates of service in excess of 30 days.

 

Evidence of Timely Filing

 

Payors will only reconsider claims previously denied for timely filing if proof of timely filing is included with the resubmission, and the proof meets the payor's criteria for acceptable evidence of timely filing.

  • HNS can provide evidence of timely filing IF the claim was successfully electronically transmitted by HNS to the payor, and was transmitted consistent with the payor timely filing requirements.
  • HNS cannot provide evidence of timely filing for any paper claims which are submitted with attachments OR for corrected claims (or for any document(s) which cannot be electronically transmitted to the payor).  Such claims (and documents) must be mailed by HNS, via the USPS, to the payor and when claims are mailed, the "date received" established by the payor is the date the payor representative opens the envelope and date-stamps the claim.  As HNS has no control over the delivery of mail by the USPS, or by payor processes, HNS is unable to provide proof of if or when the payor receives paper claims or documents sent by HNS.

 

Important Notes to Remember:

  • As a general rule, all claims received electronically (via HNSConnect or Office Ally) are electronically transmitted to the payor within 2 business days of receipt.
  • As a general rule, paper claims received from the provider are mailed to the payor within 3 business days of receipt.

 

NC Payors - Timely Filing Limits

 

It is important to note that payors expect physicians to conduct timely follow up on outstanding claims and to take appropriate action to resolve the issues within the established timelines.

  1. BCBSNC Federal Employee Plan (FEP)
    Claims must be submitted by 12/31 of the year following the date of service.
  2. BCBSNC State Employees Health Plan
    Claims must be submitted within 18 months from the date of service.
  3. BCBSNC Commercial Plans (including out-of-state plans)
    Claims must be submitted within 180 days from the date of service.
    (The BCBSNC timely filing policy supercedes the out-of-state plan's timely filing policy.)
  4. BCBSNC Secondary Claims
    Claims must be filed within 180 days of the date of service.
  5. BCBSNC Corrected Claims
    Corrected claims must be filed within 12 months from the date of service.
  6. CIGNA Healthcare (commercial plans)
    Claims must be filed within 180 days of the date of service.
  7. CIGNA Healthspring (Medicare plan)
    Claims must be filed within 120 days of the date of service.
  8. HealthTeam Advantage (Medicare plan)
    Claims must be filed within 45 days of the date of service.
  9. Liberty Advantage (Medicare plan)
    *Contract effective 1/1/2018
    Claims must be filed within 12 months from the date of service.
  10. MedCost
    Timely filing limits vary.  Always verify timely filing requirements with the third party payor.

 

SC Payors - Timely Filing Limits

 

It is important to note that payors expect physicians to conduct timely follow up on outstanding claims and to take appropriate action to resolve the issues within the established timelines.

  1. CIGNA Healthcare (commercial plans)
    Claims must be filed within 90 days of the date of service.
  2. CIGNA Healthspring (Medicare plan)
    Claims must be filed within 120 days of the date of service.
  3. MedCost
    Timely filing limits vary.  Always verify timely filing requirements with the third party payor.
  4. Absolute Total Care (Medicaid plan)
    Claims must be filed within 12 months from the date of service.
  5. Select Health (Medicaid plan)
    Claims must be filed within 12 months from the date of service.