Highmark Timely Filing Limit: 180 or 365 Days

Highmark Blue Cross Blue Shield's first published filing rule in the reviewed sources is: Pennsylvania: 365 days from last date of service if not otherwise specified by contract. Confirm the plan, provider agreement, and event that starts the filing period before submission.

At a glance

• Timely filing varies by service area and some product lines. If contract language does not specify otherwise, Highmark states that claims must be received within 365 days of the last date of service in Pennsylvania and West Virginia, and within 180 days of the date of service in Delaware. For secondary claims, the filing clock is based on the primary payer’s finalized/payment date and an EOB must be attached. New York, PA CHIP, and some special programs have separate rules.

Initial claim filing limits

• Pennsylvania: 365 days from last date of service if not otherwise specified by contract
• West Virginia: 365 days from last date of service if not otherwise specified by contract
• Delaware: 180 days from date of service if not otherwise specified by contract
• New York (initial claims): 365 days from date of service/discharge
• PA CHIP: 180 days from date of service or discharge

Corrected claim filing limits

• New York: corrected claims (bill type ending in 7) must be received within 365 days from the last processing date of the original claim submission
• Other corrected-claim limits were not clearly stated in the public sources reviewed

Appeal and reconsideration deadlines

• If a claim denies for timely filing and the claim was previously submitted within 365 days, Highmark says to resubmit the claim and the denial with the appeal.
• No universal appeal deadline was found in the reviewed public sources.

Trigger basis and caveats

• For primary claims, the trigger is generally the last date of service; for secondary claims, it is the primary payer’s finalized/payment date as shown on the EOB.
• New York corrected claims use the processing/finalization date of the original claim.
• PA CHIP uses date of service or discharge.
• Some contract-specific or member-policy-specific periods may override the default periods.
• Timely filing may be different under contract terms or specific member policies.
• The reviewed sources do not provide one single Highmark-wide filing limit because Highmark operates multiple service areas and products.
• Some special programs have exceptions, including Early Intervention Providers, Workers Compensation, and VA Hospital/Providers in the New York guidance reviewed.

Provider resources

• Highmark Provider Resource Center home (official)
• Claims & Authorization (official)
• Authorization Guidance (official)
• Obtaining Authorizations (official)
• Electronic Claims (Submission, Status, and Inquiry) (official)
• Highmark Provider Manual (official)
• Unit 1: General Claim Submission Guidelines (official)
• Contact Highmark (official)

Sources