Billing Manual for Community Care Network Providers

Carbon/Monroe/Pike – 90 days, 180 days to complete claim processChester – 60 days, 180 days to complete claim processErie - 90 days, 180 days to complete the claim processLycoming/Clinton - 90 days, 180 days to complete the claim processNorth Central – 90 days, 180 days to complete claim process (North Central includesBradford, Cameron, Centre, Clarion, Clearfield, Columbia, Elk, Forest, Huntingdon,Jefferson, Juniata, McKean, Mifflin, Montour, Northumberland, Potter, Schuylkill,Snyder, Sullivan, Tioga, Union, Warren, and Wayne counties)Northeast – 90 days, 180 days to complete claim process (Northeast includesLackawanna, Luzerne, Susquehanna, and Wyoming counties)York/Adams – 90 days, 180 days to complete claim processCoordination of Benefits-COB Timely FileSecondary claims received outside of timely file guidelines of the respectiveHealthChoices contracts must be received within 30 days from the processed date ofthe primary insurance remittance advice.The above applies to all contracted counties.Timely File Submission RequirementsRequests for an exception to the timely file guidelines must include documentationexplaining why the exception is warranted.The following items must be included with your appeal request:Providers must forward a letter outlining the details related to the reason(s) a timelyfile appeal is being requested on organization letterhead.A copy of the original billed claim (CMS-1500 or UB-04).The claim submitted must be CORRECT, meaning all required fields are populatedaccording to this billing manual.The form number must be at the top of each claim form.The authorization must be in place.The member must be eligible for the date(s) of service billed.If the claim was billed electronically, a copy of the electronic confirmation ’997’ reportis required to be included with the appeal documents.Providers must show proof of follow-up every 45 days. Failure to complete timely filefollow-up is not an acceptable reason for requesting a timely file exception.Claims must be on file prior to requesting a Timely File appeal.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 101