Bcbs timely filing 2019 download#

Key Dates for Calendar Year 2022: Qualified Health Plan (QHP) Data Submission and Certification Rate Review and Risk Adjustment (PDF) Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, Reduced Maximum Annual Limitation on Cost Sharing, and Required Contribution Percentage for the 2023 Benefit Year (PDF) Proposed Key Dates for Calendar Year 2022: Qualified Health Plan (QHP) Data Submission and Certification Rate Review and Risk Adjustment (PDF) Proposed Key Dates for Calendar Year 2021: Qualified Health Plan (QHP) Data Submission and Certification Rate Review and Risk Adjustment (PDF)įinal Key Dates for Calendar Year 2021: Qualified Health Plan (QHP) Data Submission and Certification Rate Review and Risk Adjustment (PDF) Proposed Key Dates for Calendar Year 2020 QHP Certification in the FFEs Rate Review Risk Adjustment (PDF)įinal Key Dates for Calendar Year 2020: QHP Certification in the FFEs Rate Review Risk Adjustment (PDF) Proposed Key Dates for Calendar Year 2019: QHP Certification in the FFEs Rate Review Risk Adjustment (PDF)įinal Key Dates for Calendar Year 2019: QHP Certification in the FFEs Rate Review Risk Adjustment (PDF) Proposed Key Dates for Calendar Year 2018: QHP Certification in the FFEs Rate Review Risk Adjustment (PDF)įinal Key Dates for Calendar Year 2018: QHP Certification in the FFEs Rate Review Risk Adjustment (PDF) Revised Key Dates in 2017: QHP Certification in the FFM Rate Review Risk Adjustment and Reinsurance (PDF)įinal Revised Key Dates in 2017: QHP Certification in the FFE Rate Review Risk Adjustment, Reinsurance and Risk Corridors (PDF) Proposed Key Dates in 2017: QHP Certification in the FFM Rate Review Risk Adjustment, and Reinsurance (PDF) Coverage for Contraceptive Services ACTION: Request for information Key Dates in 2016: QHP Certification in the FFM Rate Review Risk Adjustment, Reinsurance and Risk Corridors (PDF)įinal: Key Dates in 2016: QHP Certification in the FFM Rate Review Risk Adjustment, Reinsurance and Risk Corridors (PDF) Key Dates in 2015: QHP Certification in the FFM Rate Review Risk Adjustment, Reinsurance, and Risk Corridors (PDF) Group Health Plans that Fail to Cover In-Patient Services (PDF)

Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Self-Funded Non-Federal Governmental Plans.

Consumer Operated and Oriented Plan (CO-OP) Program.

Early Retiree Reinsurance Program (ERRP).

Pre-Existing Condition Insurance Plan (PCIP).

Language Access Guide for Exchanges, Qualified Health Plan (QHP) Issuers, and Web-Brokers.

Summary of Benefits and Coverage and Uniform Glossary.

Good Faith Estimates for Uninsured (or Self-pay) Individuals.

Medicare Provider Cost Report Public Use Files.

Provider statistical & reimbursement report.

Medicare fee for service for Parts A & B.

Medicare Claims Synthetic Public Use Files (SynPUFs).

Health Care Information System (HCIS) data file.

Medicare Provider Utilization and Payment Data.

Bcbs timely filing 2019 download#

Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files for Download.Next Generation ACO Model (NGACO) Public Use Files.Medicare Advantage/Part D Contract and Enrollment Data.Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model Public Use Files.To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. If a claim for payment under Medicare has been filed in a timely manner, the Fiscal Agent must receive a SoonerCare claim relating to the same services within 90 days after the agency or the provider receives notice of the disposition of the Medicare claim.ĭisclaimer. The OHCA rules found on this Web site are unofficial.

(c) To be eligible for payment under SoonerCare, claims for coinsurance and/or deductible must meet the Medicare timely filing requirements. (b) Claims may be submitted anytime during the month. A denied claim can be considered proof of timely filing. Payment will not be made on claims when more than 6 months have elapsed between the date the service was provided and the date of receipt of the claim by the Fiscal Agent. For dates of service provided on or after July 1, 2015, the timely filing limit, for SoonerCare reimbursement, is 6 months from the date of service. Federal regulations provide no exceptions to this requirement. (a) According to federal regulations, the Authority must require providers to submit all claims no later than 12 months from the date of service.