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Late Claim Filing

The HealthPlus claims processing system will deny a claim if the claim is billed more than one year from the Date of Service (DOS). If a provider bills after the defined claim filing period, a late filing appeal will be required.

Continuous Care

When a provider bills for continuous care, late filing is determined by the date on which the continuous care ends. 

 

Type of Care

Late Filing Date

Inpatient stay

Consider late filing from discharge date

Inpatient hospital day care

Consider late filing from discharge date

OB care

Consider late filing from delivery date

Coordination of Benefits (COB)

For claims requiring coordination of benefits, use the payment date located on the primary insurances EOP as the starting date to calculate the late filing period.

For example:  DOS is 03/05/07. EOP date is 06/05/07. Use 06/05/07 as starting date to calculate late filing.

Claims Adjustments

Providers have one year from the DOS, for a rebilled claim to be resolved, including resubmissions.

The provider will need to appeal any late filing denials.

Replacement Claims

Providers may re-bill a claim up to one year from the DOS, including replacement claims. If your claim denies for late filing because the resubmission exceeds one year from the DOS, the denial will remain in effect. Providers, who feel they have extenuating circumstances, can appeal the late filing determination with Provider Network Management.  

If you have questions regarding late claim filings, contact Provider Network Management at: (810) 230-2172.

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