Retroactive claim denialsįlorida Blue doesn’t request refunds for claims paid when a member’s termination date is adjusted retroactively unless the enrollee is ending their BlueDental plan and enrolling in another insurer’s dental plan. The best ways to prevent denials are to pay your premiums on time, talk to your providers about what’s covered before you get services and know your BlueDental plan benefits.
Getting a service that’s not a benefit of your plan. Not getting preauthorization for a service that requires it. If the provider doesn’t verify eligibility over the phone or electronically, the service may be denied when the claim is filed. Using an expired Florida Blue membership card to get services. There are certain cases when a claim for dental services may be denied even after you’ve received the service and the claim has been paid. If you’re not satisfied with the information you receive and you’d like to pursue a claim for coverage, you may request an appeal. If you disagree with our decision to deny your claim or request for coverage, please call us for help. If any of the services on your claim are denied, the EOB will explain why. If we need more information, you’ll have at least 45 days to provide it to us. We’ll let you know within 30 days why we’re extending our response time and when you can expect our decision. However, if we need more information or are unable to make a decision due to circumstances beyond our control, we’ll extend our response time for 15 days. If we receive all the information we need to process your claim, we’ll send you an EOB within 20 days (electronic claim) and 40 days (paper claim) of receiving your claim. You can choose paperless EOBs by selecting the option in your account portal. Each time you receive an EOB, review it closely and compare it to the receipt or statement from your dentist. 
How much has been credited toward any required deductible or annual maximum. Any balance you’re responsible for paying the provider. An EOB is a statement that explains how we processed a claim based on the services performed. Explanation of BenefitsĮach time you visit the dentist, we will send you an Explanation of Benefits (EOB) statement. If the premium is not received prior to the end of the grace period, the policy will be canceled. During the second and third months of the grace period, claims may pend and be denied if past due premiums are not received. If you purchased your plan On-Marketplace and you receive a subsidy to help pay for your coverage, claims will be paid during the first month of the grace period for all eligible dental services rendered. You’ll lose coverage back to the last paid through date and be responsible for any claims for services you received after that date. If you don’t, your policy will be canceled. To keep your coverage, you’ll need to pay your premium before the end of the three months. If you purchased your BlueDental plan directly from Florida Blue (Off-Marketplace plans) or you purchased a plan On-Marketplace but you do not receive a subsidy, your coverage will be active during this three-month grace period. The grace period for non-ACA Individual and group plans is 31 days. For individual Affordable Care Act (ACA) plans, we allow a three-month grace period to pay each premium after the initial premium. If you are enrolled in an individual BlueDental Choice or BlueDental Copayment Q or QF plan, and do not pay your premium on or before the due date, you are entitled to a grace period. 
Send your claim to Florida Combined Life, P.O. Statements that you prepare, cash register receipts, receipt of payment notices, or balance due notices will not be accepted.
#Il bcbs timely filing limt code#
Description of each service using the correct Common Dental Terminology code (CDT)Ī claim without a provider statement will be denied. The provider statement must include all of the following: Information about other dental coverage you may haveĮnclose an itemized statement of services received from your dentist in English or a statement in a foreign language with an English translation on the provider’s stationery. Your BlueDental member ID number (the number is printed on your member card). 
You must file your claim within one year after the last day you received services claims filed after one year aren’t eligible for payment.Įnclose a signed letter with your claim that includes the following: How do I submit a claim?Ĭomplete a separate claim form for each covered member who received services and each provider. Please check with your dentist for clarification, as out-of-network providers are not required to submit claims on your behalf. BlueDental participating dental providers and some out-of-network providers will file claims for you, but you may be required to submit a claim form for services received from an out-of-network dentist.
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