Payor (Claim) Timelines for App

Payor	Primary Claim	Non-Primary Claim	Appeal
Arbor Medicaid	365 days	60 days	90 days
Avera	90 days	60 days on COB	180 days
BCBS Network PPO (changed 1/1/10)includes Blue Select(exeption: Mosaic-120 days)	180 days	180 days	365 days
BCBS Federal	By 12/31 the year after the service was provided	By 12/31 the year after the service was provided	90 days or before the timely filing period is exhausted; whichever is later
CoOpportunity	365 days	365 days	365 days
Coventry CareLink	180 days	180 days	365 days
Coventry HMO	180 days	180 days	365 days
Coventry Medicaid (changed 6/1/14 but is retro to 9/2013)	180 days	180 days	365 days
Coventry PPO (changed 6/1/14)	180 days	180 days	365 days
First Health – Please note you have to know what network they are utilizing; if it is Coventry then you need to refer to Coventry’s information.	365 days	365 days	90 days
Health Alliance	365 days	365 days	365 days
Humana Choicecare	120 days	120 days	within 180 days of when the member receives the adverse determination.
IA Medicaid	365 days	365 days	365 days
KS Medicaid	12 months	12 months	Providers must request in writing an administrative fair hearing; the request must be received within 30 days of the date of the notification (3 days are added for mailing time).
MHNet	180 days	180 days	365 days
Midlands Choice (all payors)	180 days	180 days	180 days
MultiPlan	12 months	12 months	12 months
Nebraska Medicaid	180 days (effective 9/1/13)	180 days (effective 9/1/13)	90 days
Sanford Health	120 days	60 days	within 180 days of the date of service; if claim is past the 120 day timely filing date then you have 60 days from the date EOP was issued.
SD Medicaid	6 months	6 months	3 months
Tricare	365 days	365 days	365 days
UHC	120 days	120 days	120 days
UHC Community Plan – CP	180 days (effective 9/1/13)	180 days (effective 9/1/13)	90 days
UHC Community Plan – Hosp/Sp	180 days (effective 9/1/13)	180 days (effective 9/1/13)	90 days