(Filing Wellpoint Appeals continued) FORMS OF ACCEPTABLE PROOF ELECTRONIC a clearinghouse report demonstrating the actual submission of the claim to the anthem blue cross anthem edi gateway within the timely filing limit level 2 status reports generated by anthem edi gateway demonstrating submission of the claim or acceptance of the claim within timely filing limit dated request for additional information from anthem (mailback) claim denial letter or ra/eob from anthem for edi claims that could not be processed by anthem HARD COPY a computer-generated claim transaction history with the anthem name from a billing system a dated request for additional information from anthem (mailback) a claim denial letter or ra/eob from anthem a denial letter from other insurance carrier dated and printed on letterhead a dated ra/eob from another insurance carrier Proof of member billing 32 hbma billing • may. june.2013 ITEMS TO VERIFY ACCEPTABLE PROOF ELECTRONIC • Proof must be from a clearinghouse and must show at least one of: the actual anthem response to the submission of the electronic claim a positive acceptance message from anthem a report from the facility or its clearinghouse objectively demonstrating that the claim was in fact submitted to anthem • submission dates must be included and fall within the filing limits from the dos • Verify that the claim was received and accepted for processing • confirm the date of submission is within the filing limits • ensure dates are within the filing limitations from dos to anthem letter date • Verify member information and dates of service • ensure ra/eob/denial letter date demonstrates that facility’s submission was within the filing limit • anthem letter must indicate the original submission was within the filing limit or a batch number or error report must be included to verify submission to anthem HARD COPY • correct anthem address must be indicated (on ledger or a code listing) • must include complete billing history • follow-up attempts must be made consistently and within a reasonable amount of time • follow-up information must include dates, names, and other pertinent details • ensure dates are within the filing limitations from dos to anthem letter date • Verify member information and dates of service • ensure ra/eob/denial letter date demonstrates that facility’s submission to anthem was within the filing limit • letter must have valid letterhead • letter must be dated • claim to anthem must be within the filing limit starting from the date of the letter • ra/eob must demonstrate that submission to other insurer was within anthem’s timely filing limit • claim to anthem must be within the filing limit starting from the date of the ra/eob • Patient billing history must demonstrate follow-up attempts within a reasonable period of time • follow-up attempts must be made within the timely filing limit Figure 1
Billing_MJ13
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