CHRISTUS Health Plan Timely Filing Limit

The most important thing to confirm with CHRISTUS Health Plan 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

• Timely filing limits vary by line of business, claim type, and sometimes submission channel. Official policy OPC23 states the receipt date is when the claim enters CHP's claims clearinghouse system unless otherwise agreed in contract. For Texas and Louisiana HIX, Medicare Advantage, USFHP, and NCHD, separate limits apply. For Louisiana HIX, paper and electronic filing limits differ. For COB claims, submission must be within 120 days of the primary payer's determination and include the primary payer EOP.

Initial claim filing limits

• US Family Health Plan: 365 calendar days from date of service for non-institutional/professional; 365 calendar days from date of discharge for institutional
• CHRISTUS Health Plan Medicare Advantage: 365 calendar days from date of service for non-institutional/professional; 365 calendar days from date of discharge for institutional
• Texas Health Insurance Exchange: 95 calendar days from date of service for non-institutional/professional; 95 calendar days from date of discharge for institutional
• Louisiana Health Insurance Exchange: Paper claims 45 calendar days from date of service/date of discharge; electronic claims 30 calendar days from date of service/date of discharge
• Nueces County Hospital District: 120 calendar days from date of service/date of discharge
• COB claims: within 120 days of receipt of the primary payer's determination

Corrected claim filing limits

• Corrected claims must be submitted within the relevant timely filing period indicated for the line of business
• Corrected facility claims must include bill type code XX7
• Corrected professional claims must include resubmission code 7

Appeal and reconsideration deadlines

• Not clearly published in the researched sources.

Trigger basis and caveats

• For non-institutional/professional claims, timeliness is measured from the line-item 'From' date of service when spans are present.
• For inpatient institutional claims, timeliness uses the 'Through' date on span-date claims, or date of discharge.
• For outpatient institutional claims, timeliness uses the line-item date of service.
• Claims received on weekends or holidays are stamped with the following business day in the Medicare Advantage manual.
• Receipt date is defined as the date the claim is received into CHP's claims clearinghouse system unless otherwise agreed by contract.
• The official policy says claims not received before the applicable timely filing deadline will be denied.
• No generic appeal deadline for timely filing denials was located in the official sources reviewed.
• For Louisiana HIX, the filing limit differs by paper vs electronic claims.
• Contract terms may override the default receipt date/timely filing rules.

Provider resources

• Provider Resources (official)
• Provider Portal (official)
• Prior Authorization Forms and Lists (official)
• Quick Reference Guides and Manuals (official)
• Provider Forms (official)
• Policies and Procedures (official)
• Provider Relations Team (official)

Sources