PacificSource Community Solutions Timely Filing Guideline: Effective 1/1/2012

12/23/2011 10:07:13 AM
PacificSource Community Solutions identified an error in our Provider Manual in regards to Claims Submission Requirements.
 
Currently, the provider manual states:
 
·         COIHS plans accept claims within 120 days from date of service
·         Providers have up to 1 year from the date of service to re-submit claims for reprocessing. This is an out-of-date guideline.
·         When Clear One is secondary submit your claim with the primary carrier’s EOB. Providers have up to 1 year from the date of payment/denial from the primary carrier to submit to Clear One.
 
This guideline is out-of-date.
 
 
Effective 1/1/2012, PacificSource Community Solutions will be instituting the following guideline for dates of service on or after 1/1/2012.
 
·         PacificSource Community Solutiions accept claims within 120 days from the date of service.
·         Providers have up to 120 days from the date printed on the original Explanation of Benefits to re-submit claims for reprocessing.
·         When PacificSource Community Solutions is secondary, submit your claim with the primary carrier’s EOB. Providers have up to 120 days from the date of payment/denial from the primary carrier to submit to PacificSource Community Solutions.
 
PacificSource Community Solutions is working to revise the Provider Manual for the government lines of business. We will notify providers when the new manual is available.
 
Please Note: Any claims with dates of service prior to 1/1/2012 will follow the previous guideline.
 
 
If you have questions or need additional information regarding this notification, please contact your PacificSource Provider Service Representative.

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