Select Health Timely Filing Limit

The most important thing to confirm with Select Health 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 Select Health Commercial and Government plans, claims submitted directly to Select Health must be filed within 12 months of the date of service. The manual also states that the filing period can vary by individual provider contract. For secondary-payer COB situations, supporting information must be submitted within 12 months after the claim was processed by the primary plan. If a claim was filed to the wrong primary insurer, it can be re-filed to the appropriate primary plan within 24 months of the date of service without penalty. Provider appeal deadlines vary by line of business.

Initial claim filing limits

• 12 months from the date of service for claims submitted directly to Select Health (Commercial and Government plans)
• Secondary-payer COB supporting information: within 12 months after the claim was processed by the primary plan
• Wrong-primary-insurer COB re-file: within 24 months of the date of service without penalty
• Contract-specific timely filing periods may differ

Corrected claim filing limits

• Not clearly published in the researched sources.

Appeal and reconsideration deadlines

• Provider appeals: within 180 days for Commercial and Medicare claims, and within 90 days for Medicaid claims, from the date the claim was processed
• Medicare pre-service appeal: within 60 calendar days from the date of the coverage determination
• Medicare standard appeal notice references separate CMS-level appeal timelines; see the Medicare-specific section of the manual

Trigger basis and caveats

• Claim filing limit is measured from the date of service for direct claims.
• COB filing limit is measured from the date the claim was processed by the primary plan.
• Provider appeal filing limit is measured from the date the claim was processed.
• The manual explicitly says the filing period can vary per individual provider contract.
• This record does not include a separate corrected-claim timely filing rule because none was found in the official sources reviewed.
• Appeal deadlines are separate from claim filing deadlines.

Provider resources

• Provider Reference Manuals (official)
• Provider Benefit Tool (official)
• Provider Access Point / Join Our Networks (official)
• Preauth & Care Plan Tool announcement (official)
• Claims submission / EDI resources (official)

Sources