Blue Cross and Blue Shield of Florida dba Florida Blue Timely Filing Limit

The most important thing to confirm with Blue Cross and Blue Shield of Florida dba Florida Blue is not just the number of days, but also what event starts the clock. Some payer documents measure from date of service, some from discharge, and some publish different rules for corrected claims or appeals.

At a glance

• Florida Blue’s provider manual says providers must file claims within the time set forth in their participating provider agreement, and notes that current Florida law and other legal requirements may require claims within 180 days after date of service and receipt of the member insurer’s name/address. The manual also states all claim submissions have a 180-day timely filing limit for claims and supplemental claims must be submitted within 180 days of the original E&M service. A separate member-facing transparency page states post-service member claims must be received within 90 days, but that appears to apply to enrollee-submitted post-service claims rather than provider-filed claims.

Initial claim filing limits

• 180 days in the provider manual for all claim submissions, including a note that timely filing may be governed by the provider agreement and applicable law
• Current Florida law/other legal requirements may require claims within 180 days after date of service and receipt by the provider of the member insurer’s name and address

Corrected claim filing limits

• Corrected claims are treated as a resubmission after original processing; the manual does not give a separate corrected-claim filing deadline in the cited sections
• Supplemental claims must be submitted within 180 days of the original E&M service

Appeal and reconsideration deadlines

• No specific appeal deadline found in the cited provider materials

Trigger basis and caveats

• Provider manual cites date of service and, where applicable, receipt by the provider of the member insurer’s name and address.
• Member transparency page separately uses post-service claim receipt deadlines for enrollee claims.
• Timely filing can vary by provider agreement and applicable law.
• The member transparency page is not necessarily the same rule set as provider billing rules.
• No separate corrected-claim deadline was located in the cited official provider manual sections.

Provider resources

• Provider Manual (official)
• Provider Prior Authorization (official)
• Provider Availity Online Services (official)
• Provider News (official)
• Claims / Using Your Coverage: Claims (official)
• Transparency in Coverage (official)

Sources