This article is for all providers caring for our members
We previously notified you via News Alert that effective for claims with processed dates on or after October 1, 2025, we will change the timeframe in which you are able to submit follow-up correspondence for your claims. This update closely aligns with similar timeframes of other local health plans and applies to all appeals, corrected claims, and replacement claims for our commercial, Medicare Advantage, and FEP members.
|
Type of correspondence |
Current timeframe to submit |
New timeframe to submit starting October 1, 2025 |
|---|---|---|
|
First appeal |
One year from the processed date of the claim |
180 days from the processed date of the claim |
|
Second appeal |
One year from the processed date of the claim |
60 days from the determination date of the first appeal |
|
Corrected claim |
One year from the processed date of the claim |
180 days from the processed date of the claim |
|
Replacement claim |
One year from the processed date of the claim |
180 days from the processed date of the claim |
To read our original News Alert, log on to bluecrossma.com/provider and click News. Scroll down to June 3, 2025 and look for the red exclamation point.