IL BCBS TIMELY FILING LIMT HOW TO

If your physician prescribes a specialty drug that appears on our FEP Blue Focus Specialty Drug List, your physician may order the initial prescription by calling our Specialty Drug Pharmacy Program at 88, TTY: 87, or you may send your prescription to: Specialty Drug Pharmacy Program, AllianceRx Walgreens Prime, P.O. Note: For overseas pharmacy, see page 106. Non-Preferred Retail Pharmacies: There are no benefits for drugs or supplies purchased at Non-preferred retail pharmacies. See the following paragraphs for claim filing instructions. You did not obtain prior approval when required (see page 21).You do not use your valid ID card at the time of purchase or.Note: Even if you use Preferred retail pharmacies, you will have to file a paper claim form to obtain reimbursement if: You pay the applicable coinsurance or copayment. We reimburse them for your covered drugs and supplies. Preferred retail pharmacies file your claims for you. To find a Preferred retail pharmacy, visit If you use a Preferred retail pharmacy that offers online ordering, have your ID card ready to complete your purchase. Preferred Retail Pharmacies – When you use Preferred retail pharmacies, show your ID card. If you do not agree with our initial decision, you may ask us to review it by following the disputed claims process detailed in Section 8 of this brochure. If we need an extension because we have not received necessary information (e.g., medical records) from you, our notice will describe the specific information required and we will allow you up to 60 days from the receipt of the notice to provide the information. Our notice will include the circumstances underlying the request for the extension and the date when a decision is expected. If matters beyond our control require an extension of time, we may take up to an additional 15 days for review and we will notify you before the expiration of the original 30-day period. We will notify you of our decision within 30 days after we receive your post-service claim.

IL BCBS TIMELY FILING LIMT HOW TO

(See pages 95- 97 for information on how to obtain benefits from the Retail Pharmacy Program and the Specialty Drug Pharmacy Program.) We may request updated treatment plans as your treatment progresses.Ĭlaims for prescription drugs and supplies that are not received from the Retail Pharmacy Program must include receipts that show the prescription number, name of drug or supply, prescribing provider’s name, date, and charge. Claims for dental care to repair accidental injury to sound natural teeth should include documentation of the condition of your teeth before the accidental injury, documentation of the injury from your provider(s), and a treatment plan for your dental care.If your claim is for the rental or purchase of durable medical equipment, home nursing care, or physical, occupational, speech, or cognitive rehabilitation therapy, you must provide a written statement from the provider specifying the medical necessity for the service or supply and the length of time needed.

Bills for home nursing care must show that the nurse is a registered or licensed practical nurse.

If another health plan is your primary payor, you must send a copy of the explanation of benefits (EOB) form you received from your primary payor (such as the Medicare Summary Notice (MSN)) with your claim.

Note: Canceled checks, cash register receipts, balance due statements, or bills you prepare yourself are not acceptable substitutes for itemized bills.

Dates that services or supplies were furnished.

Name and address of person or company providing the service or supply.

Patient’s name, date of birth, address, phone number, and relationship to enrollee.

Bills and receipts should be itemized and show: For long or continuing inpatient stays, or other long-term care, you should submit claims at least every 30 days. Use a separate claim form for each family member. When you must file a claim – such as when another group health plan is primary – submit it on the CMS-1500 or a claim form that includes the information shown below. Your facility will file on the UB-04 form. Your provider must file on the CMS-1500, Health Insurance Claim Form.

Just present your ID card when you receive services. To obtain claim forms or other claims filing advice, or answers to your questions about our benefits, contact us at the customer service phone number on the back of your ID card, or at our website at In most cases, physicians and facilities file claims for you. See Section 3 for information on pre-service claims procedures (services, drugs, or supplies requiring precertification or prior approval), including urgent care claims procedures. This Section primarily deals with post-service claims (claims for services, drugs, or supplies you have already received).

Il bcbs timely filing limt