Corrected SNF claims for Medicare Plus Blue^SM members: Some claims denied due to untimely filing will automatically process for payment after Feb. 2, 2021

Blue Cross Blue Shield of Michigan and Blue Care Network recently reviewed paid skilled nursing facility claim records with dates of service from June 1 to Sept. 30, 2019, for Medicare Plus Blue and BCN Advantage^SM members. The purpose of the review was to verify that the billed services matched the services naviHealth authorized.

If we identified duplicate, overbilled or unverified services on paid claims, you received a letter notifying you that you have 90 days to submit corrected claims that align with the services naviHealth authorized.

However, when you submit corrected claims for Medicare Plus Blue members, you'll receive a denial due to untimely filing. This occurs because our systems are set up to automatically issue denials for claims that are submitted more than one year since the date of service.

You don't need to take any action as a result of the denial. We're identifying these claims and will process them for payment after Feb. 2, 2021.

This issue doesn't affect submissions of corrected SNF claims for BCN Advantage members.

As a reminder, naviHealth manages authorization requests for Medicare Plus Blue and BCN Advantage members admitted to post-acute care on or after June 1, 2019. For more information about naviHealth, see the Post-acute care services: Frequently asked questions for providers document.

Posted: December 2020
Line of business: Blue Cross Blue Shield of Michigan