Claims review

Timely filing for In network inpatient services

• 14 months following the date of discharge for an inpatient admission

• 370 days months following the date of discharge for an inpatient admission

• 12 months following the date of discharge for an inpatient admission

• 24 months following the date of discharge for an inpatient admission

when member receives medical, dental, vision or mental health services, this is filled to request payment for those services from the plan.

Will a claim be approved if submitted after the timely filing?

• No

• Yes

• Provider can have an exception due to loyalty

• Provider can submit claims at any time

Where can you find others BlueCross and BlueShield contact information?

• Alert - BCBSA Plan

• JobAid Blue Card information

• JobAid BCBS contact list

• Alert - Plan to plan contact list

CLM# 20241205509521, is this a claim processed by IBX therefor you can give information?

• Claim is rejected therefore I do not handle the claim

• Yes, it's our claim

• No, it's not our claim

• That claim is not showing on any system

Clm# 20250621566921, what's the reason of denial?

clm# 20250501500725, provider is calling you to know claim status, what would you say?

• I need to connect the call to claims department

• Claim is not from us, claim was sent to Highmark plan area 378

• This is our claim, it was sent to Highmark plan area 378

clm# 20240327506766, is there any patient responsibility, if so, why?

• That claim was not found on any system

• There is only a payment $127.62, no patient responsibility

• Yes, patient liability of $60 due to copay

• No patient liability, insurance has allowed $187.62

clm# 20240117504588, is the claim approved or denied? explain the reason why

• Approved, allowed amount applied to Deductible

• Denied - Due to timely filing

• Approved- there is a payment for $277.29

• Denied - the service is not reimbursable. The facility provider was already paid in full.

Claim# 20240203501213, when was the claim approved and finalized? what's the denied reason?

• 02/02/2024 - 06/18/2024 and denied due to taxonomy code invalid/missing

• 12/02/2024 - 06/18/2024 and denied due to taxonomy code invalid/missing

• 02/02/2024 - 02/02/2024 and denied due to taxonomy code invalid/missing

• 02/02/2024 - 06/18/2024 and denied due service not covered