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The Podiatric Pulse (Issue No 1)

Dear Members of Los Angeles County Podiatric Medical Association:

We are pleased to announce the launch of our new email newsletter, Podiatric Pulse. This is our first issue and we will be creating monthly newsletters to highlight important topics affecting you and your practice. Please let us know what you think of the newsletter in the coming months, including sharing topics you would like to have covered.

Change to Anthem Blue Cross Timely Filing Requirements

As of October 1, 2019, Anthem Blue Cross changed their timely filing requirements from 365 days to 90 days. Unfortunately, Anthem announced this change in June which left very little time for providers to adjust their billing practices to meet the deadline.

Anthem’s new policy states they will refuse payment of claims submitted more than 90 days after the date of service, and they believe the notice they gave providers was sufficient to comply with the change. We disagree. Fortunately, there is a law under the California Insurance Code (1) regarding unfair payment practices, which provides a “good cause” exception that requires payors to accept and adjudicate claims if the physician demonstrates “good cause” for the delayed claim. It is our opinion that Anthem’s idea of sufficient advance notice did not allow for enough time to process older claims which would have fallen under the 365-day window of timely filing, which is the “good cause” for the delay in submission.

We advise you to send in all claims immediately to make sure you meet current guidelines. The older claims which they say they will refuse payment should be appealed with date of submission along with referencing the “good cause” Insurance Code INS § 10133.66.

Regarding claims with Anthem Blue Cross as a secondary insurance to a primary insurance policy with a less stringent timely filing requirement, such as Medicare, the Anthem website does address this concern, stating: “If Plan is the secondary payor, the ninety day period will not begin until Provider receives notification of primary payor’s responsibility.” Thus, you are able to bill Medicare within 365 days with the understanding that the secondary claim to Anthem will be 90 days timely filing after you receive your Medicare payment.

Please let us know of any denials that you encounter so we can create a database to track wins and losses. Knowledge is power and data is the new knowledge. Please assist us in collecting this data so that we have the knowledge needed to fight these insurance companies.

Again, we encourage everyone to share their ideas or thoughts on this. We have strength in our numbers! I look forward to continuing to serve you.

Thank you,

Ara Kelekian, DPM, FACFAS President, LACPMA

(1) California Code, Insurance Code - INS § 10133.66 A health insurer shall comply with all the following:(a) Deadlines shall not be imposed for the receipt of a claim from a professional provider who submits a claim on behalf of an insured or pursuant to a professional provider's contract with a health insurer that is less than 90 days for contracted providers and 180 days for non-contracted providers

after the date of service, except as required by any state or federal law or regulation.  If a health insurer is not the primary payor under coordination of benefits, the insurer shall not impose a deadline for submitting supplemental or coordination of benefits claims to any secondary payor that is less than 90 days from the date of payment or date of contest, denial, or notice from the primary payor.  A health insurer that denies a claim because it was filed beyond the claim filing deadline shall, upon provider's demonstration of good cause for the delay, accept and adjudicate the claim according to Section 10123.13 or 10123.147 , whichever is applicable.  This subdivision shall not alter or affect any rights providers may have under any applicable statute of limitations or anti-forfeiture provisions available under the laws of the State of California.

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