Scott and White Health Plan Timely Filing Limit

The most important thing to confirm with Scott and White 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

• For the commercial provider manual, initial claims must be received within 95 days of date of service. For COB claims, the 95-day clock runs from the primary payer EOB date. Corrected claims are treated as replacement claims and must be submitted within 90 days from the date of determination on the initially filed clean claim. Medicare-related manual language references a 365-day initial filing deadline for Medicare claims, but the provider manual reviewed is commercial-focused and the Medicare statement is presented there as a comparison.

Initial claim filing limits

• Commercial: 95 days from date of service
• COB claims: 95 days from primary payer EOB date
• Medicare (per commercial manual comparison): 365 days

Corrected claim filing limits

• 90 days from the date of determination on the initially filed clean claim

Appeal and reconsideration deadlines

• Not a claims filing deadline, but provider complaints must be received within 60 days of the specific event on which the complaint is based.
• Appeal timelines in the manual are generally 30 calendar days for standard appeal decisions and up to 72 hours for expedited appeals.

Trigger basis and caveats

• The commercial manual states the filing deadline is based on date of service for initial claims.
• For COB claims, the trigger is the primary payer's EOB date.
• For paper claims, the receipt date is when the claim reaches the mailroom; claims received after 2 p.m. are treated as received the next business day.
• The reviewed sources do not provide a separate, definitive timely filing policy page for every line of business.
• The Medicare 365-day reference appears in the commercial provider manual as a comparison and should be verified against Medicare-specific guidance before use.
• Claims rejected as non-clean are considered never received and still must be corrected/resubmitted within the filing deadline.

Provider resources

• Provider Resources (official)
• Claims & Billing (official)
• Medical Resources (official)
• Pharmacy Resources (official)
• Commercial Provider Manual (PDF) (official)

Sources