Participating practitioners may not bill the patient for services that EmblemHealth has denied because of late submission. Reimbursement may be reduced by up to 25% for timely filing claims denials that are overturned upon successful appeal. UnitedHealthcare (UHC) recently announced in its November Network News that beginning February 1, 2023, providers will be required to submit claim reconsiderations and post-service appeals electronically for UHC commercial and Medicare Advantage products. health coverage, you must file a Health Benefits Application with your former employer. 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: United HealthCare Group Medicare Advantage Plan. Medicaid, and Child Health Plus (CHPlus): 15 months.īehavioral health providers should reference the Carelon Behavioral Health Provider Handbook for applicable timely filing limits.ĭental providers should reference the Office Manager’s Handbook section 3.1 for applicable timely filing limits.Īppealing Claims Denied for Late Submission.Self-Funded Group Out-of-Network Timely Filing Limits Commercial: 18 months, except for members affiliated with self-funded groups that have set their own limits as shown in the following table:.Self-Funded Group In-Network Timely Filing LimitsĬlaims must be received within the following time frames after the date-of-service or primary carrier’s explanation of payment (EOP) issue date when EmblemHealth is the secondary payer: The number of days begins with the date-of-service or primary carrier’s EOP. These supersede any other contracted or published filing limits. Self-funded groups (also called administrative service organization clients or “ASO clients”) may set their own claim filing limits. Primary carrier’s explanation of payment (EOP) issue date when EmblemHealth is the secondary payer.Unless otherwise specified by the applicable participation agreement or the member’s self-funded plan’s provisions, new claims must be received within 120 days of the: Go to /claims for more information or contact Provider Services at 80.Participating Medical, Facility, and Hospital Providers Find confirmations and access letters, remittance advice and reimbursement policies.You can use the UnitedHealthcare Provider Portal to: Go to and click on the sign-in button in the top-right corner. Submit claims online using the UnitedHealthcare Provider Portal. We are committed to paying claims for which we are financially responsible within 30 days. Claim(s) that are denied for untimely filing may not be billed to a member. A timely filing limit is a constant, lingering due date that healthcare providers need to understand.
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