Univera Healthcare Timely Filing Limit

The most important thing to confirm with Univera Healthcare 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

• Univera’s public provider materials indicate that most participating provider agreements include a filing limit and that claims submitted after the time limit may deny for late filing. The provider materials also distinguish claim filing timing for Medicare Part B crossover claims and secondary claims, and they note that contract language controls timely filing requirements. A single universal filing deadline was not located in the public sources reviewed.

Initial claim filing limits

• Most participating provider agreements contain a time limit within which claims will be accepted.
• Claims submitted after that time may deny for late filing.
• Participating providers should submit claims as soon as possible after rendering service.

Corrected claim filing limits

• A corrected claim must be submitted when changes alter dollar amounts or the original billed claim.
• The public sources reviewed did not disclose a universal deadline for corrected claims.

Appeal and reconsideration deadlines

• Commercial post-service appeals: 30 calendar days from receipt of all necessary information, but no later than 60 calendar days after receipt of the appeal request.
• Self-insured post-service appeals: 60 calendar days from receipt of appeal request.
• Pre-service appeals: 30 calendar days of receipt of the appeal request.
• Expedited pre-service appeals: lesser of two business days or 72 hours of receipt.

Trigger basis and caveats

• Timely filing language may be governed by the provider contract.
• For coordination of benefits claims, the filing limit begins on the date of payment from the primary payer.
• For Medicare Part B crossover claims, Univera says providers should wait a minimum of 30 days from the Medicare payment date before submitting, and it will not service Medicare Part B claims for secondary payment before 45 days have elapsed.
• The exact filing limit may vary by contract, product, and claim type.
• The sources reviewed did not yield a single published timely filing number for all claim types.
• Appeal deadlines are not the same as timely filing deadlines.

Provider resources

• Provider home (official)
• Participating Provider Manual (official)
• Provider Contact Us (official)
• Prior Authorization (official)
• Provider FAQ (official)
• Provider Claims & Payments login (official)

Sources