| Important news:
New Coordination of Benefits (COB) ruling
Effective with dates of services on or after September
1, 2009 Asuris has changed the way COB claims are processed.
We are making the change to comply with a new rule
issued by the Office of the Insurance Commissioner
(OIC). We will no longer estimate secondary plan payments
if the primary Plan’s payment amount is unknown.
This new rule applies to all employer groups and Individual
plans. However, Employee Retirement Income Security
Act (ERISA) self-funded groups and Medicare plans are
exempt.
For more information, visit the Office
of the Insurance Commissioner Web site or contact
your provider
consultant.
COB claims for dates of service January 1,
2008 through August 31, 2009
On January 1, 2008, Asuris applied changes to our
COB claims processing guidelines to comply with a new
rule issued by the Office of Insurance Commissioner.
This rule applied to all individual and group plans (except
self-insured ERISA groups) with claims date of
service on or after January 1, 2008. It included the
following elements:
- The secondary payer must pay to the highest allowable
between two plans.
- Claims may not be denied for primary payment information.
The secondary payer must estimate the primary payment
and complete processing of the claim within 45 days.
When
claims are submitted without the primary allowed
and paid amount Asuris will call the primary insurance
plan for the claim payment detail. If we are not
able to obtain this information, claims will be pended
for that information. The COB pended claims will
show on the back of your weekly voucher in the “Claims
Pending Investigation” section. If the
primary insurance claim payment detail is not received
by the 45th day after receipt of the claim, Asuris
will estimate the primary payment at 80% of our
allowed amount and pay our portion of the claim.
Please include the following information on each electronic
or paper claim submitted:
- Charged amount
- Primary payment
- Primary allowed amount
Use one of the three options below to submit primary
payment information for a pended claim:
- Dedicated COB Fax: 1 (888) 225-4822
- Email to
secure email box
- Customer service: 1 (800) 322-1737 from 6:00 a.m.
to 6:00 p.m
Guidelines
for Timely Submission of Claims
The following guidelines apply to all types of contracted
providers and hospitals across all lines of business
including government programs.
- Original claims must be submitted within 12 months
from the date of service in order
to be processed.
- Any adjustments to the original claim must
be submitted within 24 months, or 30 months for claims
that include coordination of benefits (COB), from
the original process date.
NOTE: Non Par Providers, per Medicare
guidelines, have 26 months from the date of service
to submit a claim for Asuris TruAdvantage. Any adjustment
to the original claim must be submitted within 12 months
from the original process date.
There might be times where an exception to above guidelines
may apply (i.e. Coordination of Benefits related claim,
Adjustments, etc.). A timely filing exception is not
considered a Provider Appeal. You typically will be
required to submit documentation for proof of a timely
filing exception. If you have questions about a timely
filing denial, please contact the appropriate customer
service department.
We understand how
important the billing process is for our providers.
The information located in this section will assist
your office with claims and billing procedures. Find
out what procedure codes have supplemental edits in
place, or access the ‘Office Staff Job Tools’
section for quick, commonly used reference material.
Access our ‘Forms’ section and find out
the purpose of the form and instruction for how to
complete and submit the form.
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