You can select someone to act on your behalf at any step of the grievance and appeals process, including your physician. First Health Plans only accepts one member and one provider. You can use it by itself or with a formal letter of appeal. Claims must be submitted within the timely filing timeframe specified in your contract. longer of the timely claims filing time period requirement within your contract or the relevant member or covered persons underlying benefits contract. You can use the Member Appeal Form (PDF) to submit your appeal. You may submit written materials or testimony to help us in our review at any step of the grievance or appeals process. Under either process, we won't charge you anything extra for filing a grievance or appeal. Weve changed the standard nonparticipating-provider timely filing limit from 27 months to 12 months for traditional medical claims. The length of time you have to file an appeal will depend on whether you're eligible for an appeal under a state or federal process. Above documentation indicating that the claim was filed with the wrong division of Blue Cross and Blue Shield of Texas Documentation from BCBSTX indicating claim was incomplete Documentation from BCBSTX requesting additional information Primary carrier's EOB indicating claim was filed with the primary carrier within the timely filing deadline.
If you were unable to resolve your concern through customer service, we have a formal grievance and appeals process. It's also at the top right-hand corner of your Explanation of Benefit Payments statements. You can find the number on the back of your Blue Cross ID card. If you have a question or concern about how we processed your claim or request for benefits, contact customer service. For institutional claims, the timely filing period begins as of the DOS listed in the Through field of the Statement Covers Period of the UB-04. Blue Cross Blue Shield of Michigan wants to make sure you're satisfied with the services you receive as a member. Timely Filing Procedures The Plan claims must be submitted within 180 days of the date of service (DOS).
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