Requirements for claim submission with COB If a claim is submitted past the filing deadline due to an unusual occurrence (e.g., health care provider illness, health care provider’s computer breakdown, fire, flood) and the health care provider has a historic pattern of timely submissions of claims, the health care provider may request reconsideration of the claim. If the member has a health benefit plan with a specific time frame regarding the submission of claims, the time frame in the member’s certificate of coverage will govern.
If COB caused a delay, you have 90 days from the date of the primary carrier explanation of benefits to submit the claim to us.If an agreement currently exists between you and Oxford or UnitedHealthcare containing specific filing deadlines, the agreement will govern.Claims submitted after the applicable filing deadline will not be reimbursed the stated reason will be “filing deadline has passed” or “services submitted past the filing date” unless one of the following exceptions applies. It is not based on the date the claim was sent or received. The claims filing deadline is based on the date of service on the claim. New Jersey - 90 or 180 days if submitted by a New Jersey participating health care provider for a New Jersey line of business member.To be considered timely, health care providers, other health care professionals and facilities are required to submit claims within the specified period from the date of service:
#AETNA CLAIMS TIMELY FILING LIMIT HOW TO#
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