Changes to timely filing requirements for commercial and Medicare Advantage plans for all claims submitted to plan on or after October 1, 2019
Anthem Blue Cross and Blue Shield and HMO Colorado (hereinafter collectively referred to as Anthem) continues to look for ways to improve our processes and align with industry standards. Timely receipt of medical claims for your patients, our members, helps our chronic condition care management programs work most effectively, and also plays a crucial role in our ability to share information to help you coordinate patient care. In an effort to simplify processes, improve efficiencies, and better support coordination of care, we are changing all professional agreements to adopt a common time frame for you to submit claims.
Effective for all claims submitted to plan on or after October 1, 2019, your Anthem Provider Agreement(s) will be amended to require the submission of all professional claims for commercial and Medicare Advantage plans within ninety (90) days of the date of service. This means all claims submitted on or after October 1, 2019, will be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service.*
For instance, for a claim with a date of service of July 5, 2019, the claim would be untimely if submitted more than 90 days after that date of service (i.e. the claim would deny if submitted on or after October 4, 2019.)
NOTE: ALL CLAIMS WITH DATES OF SERVICE PRIOR TO OCTOBER 1, 2019 THAT WILL BE MORE THAN 90 DAYS FROM THE DATE OF SERVICE ON OCTOBER 1 SHOULD BE SUBMITTED PRIOR TO OCTOBER 1, 2019 TO AVOID A TIMELY FILING DENIAL.
*If Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility.
Payment methodology change / reimbursement adjustment – Consult codes and Laboratory Services done in the Provider’s Office
Anthem Blue Cross and Blue Shield and our subsidiary company, HMO Colorado (Anthem) would like to make you aware of changes to our payment methodology / reimbursement adjustment that will be effective for dates of service on or after October 1, 2019.
Anthem continues to reimburse for consult codes (99241 – 99245). Effective October 1, 2019, Anthem will adjust the reimbursement for consult codes to match the same contractual allowed amount as your contract defines for Evaluation and Management (E/M) codes.
Laboratory Services done in the Provider’s Office
Anthem is contracted with Laboratory Corporation of America® (“LabCorp”). All lab work, including Pap tests and routine outpatient pathology, must be sent to LabCorp, with the exception of the procedures that can be performed in the Provider’s office. (Please reference the Laboratory Services section of our Provider Manual for the full list of procedures that can be performed in the Provider’s office. The Provider Manual is available online; see navigation instructions below.)
Anthem continues to reimburse for laboratory services done in the Provider’s office, and no changes are being made to the services allowed in office. Effective October 1, 2019, Anthem will adjust the reimbursement for lab services performed in the Provider’s office from 100% of the Medicare year Anthem has implemented to 60% of the Medicare year Anthem has implemented.
Pathology codes are excluded from this adjustment.
Anthem’s Provider Manual is available online. Go to anthem.com. Select Providers, and Providers Overview. Select Find Resources for Your State, and pick Colorado. From the Provider Home page, under the Communications and Updates heading, select the Provider Manual link, and then select the link titled Provider and Facility Manual: February 1, 2019.
Information from Anthem Blue Cross Blue Shield and HMO Colorado.