Sunflower State Health Plan Update- Timely Filling

Sunflower State Health Plan would like to update you on timely fillings:

 

Timely Filing

·         Providers are not subject to timely filing for Sunflower State Health Plan claim reprocessing projects.

·         Sunflower State Health Plan has processes in place to waive timely filing for claim adjustments that are related to processing errors. This includes corrected claims, reconsideration to an original claim and claim disputes received from a provider. If a claim is submitted to Sunflower State Health Plan as a first time submission, the timely filing edit is automatically applied by the claims system. It is important to refer to the original claim number when submitting a corrected claim or requesting an adjustment for a claims processing error.

·         Claims must be submitted within 180 days of the date of service. When Sunflower State Health Plan is the secondary payer, the claim must be submitted within 365 days of the date of the primary carrier denial. The primary carrier remittance advice must be submitted with the claim.

·         If a provider is submitting a first time claim outside of the 180 day timely filing period, proof of the reason to waive timely filing must be submitted with the claim.

 

We have identified that many of the claims denied for timely filing are corrected claims being submitted without information for us to tie it to the original claim.  We have included information about submitted corrected claims to try to assist with this.