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 24 months, or 30 months for claims that include coordination of benefits (COB), from the original process date. Beginning January 1, 2012 adjustments to the original claim must be submitted within 18 months.

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.

To the extent the above timely claims filing guidelines are inconsistent with the terms of your participating agreement, the terms of the agreement prevail.

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.