Univera Healthcare Timely Filing Limit

Univera Healthcare's first published filing rule in the reviewed sources is: Most participating provider agreements contain a time limit within which claims will be accepted.. Confirm the plan, provider agreement, and event that starts the filing period before submission.

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