The rule change being posted for public comment is updating a specific paragraph in policy that had not been previously updated with the correct timely filing limit. The limit remains at 6 months from the date of service to submit a timely claim, and then once a claim is submitted timely, the provider has 6 more months to resubmit the claim if necessary, see OAC 317:30-3-11.1. These rule changes do not change the timely filing limits in the main section of policy that deals with timely filing, OAC 317:30-3-11. One would think 6 months would be ample time but as of late I have become increasingly skeptical in SSA's ability to assist a non-tech savvy citizen, or if the citizen has to troubleshoot their online SSA account. If OKDHS is not able to verify someone's SSI through their means it can be a significant challenge on the client to acquire that information from the SSA to provide to OKDHS. Any claim with a date of service more than 60 days old will not be. To request access to and copies of all documents, records and other information about your claim, free of charge, contact Customer Care at 80. TTY 711.Administratively, I think this makes sense, I am but slightly hesitant due to the challenges Social Security has had during the pandemic. Filing limit appeals must be received within 60 days of the original BCBSRI EOP date. Review is conducted by a non-medical appeal committee. Relates to administrative health care services such as membership, access, claim payment, etc. The grievance panel shall not expand upon or override any EGID statutes, rules, plan documents, policies and internal procedures. A non-clinical appeal is a request to reconsider a previous inquiry, complaint or action by BCBSIL that has not been resolved to the member’s satisfaction. When considering complaints by insured members, the three-member grievance panel shall determine by a preponderance of the evidence whether EGID has followed its statutes, rules, plan documents, policies and internal procedures. The entity that performs the external review depends on the nature of your appeal. If you are not satisfied with the final internal review determination due to denial of payment, coverage or service requested, you may be able to ask for an independent, external review of our decision by either an independent review organization or a grievance panel. Anthem’s New 90-day Timely Filing Requirement. Your HealthChoice plan’s internal appeals process includes two internal review levels. If you believe your situation is urgent, follow the instructions above for filing an internal appeal and also call Customer Care to request a simultaneous external review. If your situation is medically urgent, you may request an expedited appeal, which is generally conducted within 72 hours.If you choose to designate an authorized representative, you must provide this designation to us in writing. ![]() Be certain the member ID appears on each document. ![]()
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