| Ambetter Timely Filing Limit List | Ambetter Timely Filing Limit of : 1) Initial Claims 2) Reconsideration or Claim disputes/Appeals 3) Coordination of Benefits |
|---|---|
| Ambetter from Absolute Total Care - South Carolina | Initial Claims: 120 Days from the Date of Service Reconsideration or Claim Disputes/Appeals: 60 Calender Days from the date of EOP or denial is issued 120 Business Days from the date the Primary EOP is issued. |
| Ambetter from Arizona Complete Health - Arizona | Initial Claims: 120 Days from the DOS (Participating Providers) 365 Days from the DOS (Non Participating providers) Reconsideration or Claim Disputes/Appeals: 365 Calender Days from the date of EOP or denial is issued (Participating/Non Participating provider) COB: 120 Business Days from the date the Primary EOP is issued (Participating Provider). 365 Business Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from Arkansas Health & Wellness - Arkansas | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Calender Days from the date of EOP or denial is issued (Participating provider). 90 Calender Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from Buckeye Health Plan - Ohio | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Calender Days from the date of EOP or denial is issued (Participating provider). 90 Calender Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from Coordinated Care - Washington | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 24 months from the date of EOP or denial is issued (Participating/Non Participating provider). COB: 30 months from the date the Primary EOP is issued (Participating/Non Participating Provider). |
| Ambetter from Home State Health - Missouri | Initial Claims: 180 Days from the DOS (Participating Providers). 365 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating/Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 365 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from Illinicare Health - Illinois | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating provider). 90 Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from Magnolia Health - Mississippi | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating provider). 90 Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from Managed Health Services - Indiana | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating provider). 90 Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from NH Health Families - New Hampshire | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating provider). 90 Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from PA Health & Wellness - Pennsylvania | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating provider). 90 Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from Peach State Health Plan - Georgia | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating provider). 90 Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from Silversummit Healthplan - Nevada | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating provider). 90 Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from Sunflower Health Plan - Kansas | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating provider). 90 Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter from Sunshine Health - Florida | Initial Claims: 180 Days from the DOS (Participating Providers/Non Participating providers). Reconsideration or Claim Disputes/Appeals: 90 Days from the date of EOP or denial is issued (Participating/Non Participating provider). COB: 90 Days from the date the Primary EOP is issued (Participating/Non Participating Provider). |
| Ambetter from Superior HealthPlan - Texas | Initial Claims: 95 Days from the DOS (Participating Providers/Non Participating providers). Reconsideration or Claim Disputes/Appeals: 120 Days from the date of EOP or denial is issued (Participating/Non Participating provider). COB: 95 Days from the date the Primary EOP is issued (Participating/Non Participating Provider). |
| Ambetter of North Carolina Inc | Initial Claims: 180 Days from the DOS (Participating Providers). 90 Days from the DOS (Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating provider). 90 Days from the date of EOP or denial is issued (Non Participating provider). COB: 180 Days from the date the Primary EOP is issued (Participating Provider). 90 Days from the date the Primary EOP is issued (Non Participating Provider). |
| Ambetter of Tennessee | Initial Claims: 90 Days from the DOS (Participating Providers/Non Participating providers). Reconsideration or Claim Disputes/Appeals: 180 Days from the date of EOP or denial is issued (Participating provider). 90 Days from the date of EOP or denial is issued (Non Participating provider). COB: 90 Days from the date the Primary EOP is issued (Participating/Non Participating Provider). |
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