Claims Submission - Timely Filing

Date Issued: 06/20/2021

EmblemHealth would like to remind providers of the timely filing parameters for claims submissions:

 

Participating Providers:

  • Claims must be received within 120 days post-date-of-service unless otherwise specified by the applicable participation agreement.
  • Claims where EmblemHealth is the secondary payer must be received within 120 days from the primary carrier’s EOB voucher date unless otherwise specified by the applicable participation agreement.
  • Corrected claims must also be submitted within 120 days post-date-of-service unless otherwise specified by the applicable participation agreement.

Non-Participating Providers:

  • Commercial products: claims must be received within 18 months, post-date-of-service.
  • Medicaid, and Child Health Plus (CHPlus): claims must be received within 15 months, post-date-of-service.
  • Medicare: claims must be received within 365 days, post-date-of-service.

Providers who wish to appeal a claim denied for late submission should follow the provider grievance process in the Dispute Resolution chapters for the line of business: 

Reimbursement may be reduced by up to 25% for timely filing claims denials that are overturned upon successful appeal. Participating practitioners may not bill the patient for services that EmblemHealth has denied because of late submission.