COB Timely Filing Rule

Nature of Issue: Inaccurate COB Timely Filing Denials

Date Identified: 3/6/2024

Dates of Service Impacted: 1/1/2023 to Current

Product Line Impacted: MMP

Summary of Issue: Current Timely Filing Rule only taking into consideration 120 day rule, rather than consideration via either 120 day rule or the 365 day rule. Updating the system to consider the full requirement.

New Claim Submission Issue Resolution Date: March 2024 via manual intervention

Prior Claim Correction Issue Resolution Date: March 2024 via manual intervention

Any action required by the provider if applicable: Escalate any denials to your Provider Representative for overturn and review.