Updated: Aug 12, 2019
If you’re a PPO provider for Anthem Blue Cross, be prepared for changes in the contract your practice has with the health insurance company. If you haven’t already received the letter, you may want to contact Anthem to see if these changes affect your practice. You can also read the full Anthem Blue Cross letter here.
So what does this mean for your current contract and how do things change?
90 Day Timely Filing Deadline for PPO Patients
Currently, providers have one year to send a claim for patients that fall into PPO plans. The timeline for HMO patients is 90 days.
Anthem is streamlining the timeline, and requiring that practices bill for their PPO patients within the same 90 day window. This means, that you have 90 days from the date of service to submit your bill and your claim to Anthem.
If you miss the 90 day mark, the claim will be denied . Anthem will consider this billing to be untimely and late, and they will refuse to pay your bill or honor your claim.
Check and Double-Check for Correspondence
This is an easy change to miss, and if you don’t pay attention to this new deadline, your practice could be in danger of losing a lot of money through unpaid claims and rejected bills.
The letter announcing this change was dated June 21, 2019. It does not appear to have been sent by certified mail or any other method that’s easy to track or likely to gain your attention. It’s possible the correspondence could be overlooked in your office or filed away as some non-important message that doesn’t require action.
We encourage you to double-check the communications you’ve received from Anthem over the last few weeks and make sure you are in possession of this letter, which outlines a pretty significant change to their billing requirements and your contract.
July 5, 2019 Effective Date
According to the Anthem letter, PPO patients that are seen on or after July 5, 2019, will be subject to this new policy. So, you may have already seen patients for whom you will have to bill within the 90 day time-frame. You’ll need to make sure your billing department gives this the immediate and urgent attention that it requires.
The letter also instructs you to respond to their requests for additional information within either a 60 day or 90 day time-frame, depending on the situation and the information that has been requested. This is another deadline you will need to track carefully if Anthem asks for additional documentation on a billed service.
How Can Anthem Get Away With This?
Presently, COA is working closely with CMA legal counsel to ensure this notice meets California law. They are investigating whether enough notice was provided in order to effectively implement the contractual changes.
However, even if there’s a challenge, you want to make sure you comply as best you can. Otherwise, you put your practice at risk for losing valuable billing opportunities. Don’t miss the new deadlines.
We will update you if there’s a change to the implementation date set forth by Anthem Blue Cross, and we’ll also keep you in the loop if any additional changes are introduced by the company.
If you have any questions about what this means for you and your practice, please contact us at (408) 444-8845 or email@example.com
Click here to read the full Anthem Blue Cross letter.