Simply Healthcare Plans dba WellPoint Florida, Timely Filing Limit

The most important thing to confirm with Simply Healthcare Plans dba WellPoint Florida, 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

• The provider manual does not state a single universal timely-filing number in the text reviewed; instead it says claims must be submitted within the timely-filing timeframe specified in the Provider or Facility Agreement. Claims submitted after the period expires are denied unless proof of timely filing is shown. Appeals for timely-filing denials must be submitted in writing.

Initial claim filing limits

• Not stated in the reviewed manual; governed by the Provider or Facility Agreement.

Corrected claim filing limits

• Corrected claims should be resubmitted within the applicable timely-filing period if the original claim was rejected.
• The manual does not publish a separate universal corrected-claim filing deadline in the reviewed text.

Appeal and reconsideration deadlines

• Timely-filing denial appeals must be submitted in writing; no phone appeals.
• Claims payment appeals tied to reconsideration outcomes have a 90-day deadline from the reconsideration determination, but that is a different process from timely-filing appeals.

Trigger basis and caveats

• The trigger is the filing timeframe in the Provider or Facility Agreement, not a universal date in the manual.
• Proof of timely filing can include a claim copy with computer-printed filing date, an electronic acceptance/rejection report showing acceptance, or a letter requesting additional information.
• Because the actual timely-filing period is contract-specific, this response intentionally leaves the numeric limit unspecified.
• Do not assume the same timely-filing limit across all Wellpoint / Simply products.

Provider resources

• Florida provider home (official)
• Provider manual (official)
• Claims submission (official)
• Prior authorization (official)
• Policies, guidelines, and manuals (official)
• Forms and guides (official)
• Availity registration / access (official)

Sources