EmblemHealth’s self-funded groups (also called administrative service organization clients or ASO clients) may set specific plan claim filing limits that supersede those that apply to other members. Below are the current EmblemHealth ASO clients’ specific plan timely filing limits.
Group |
Plan Type |
In-Network Limit |
Out-of-Network Limit |
|---|---|---|---|
BCTGM Local 53 |
Medical |
180 days |
180 days |
BCTGM Local 53 |
Dental |
180 days |
180 days |
NFTA |
Dental |
120 days |
365 days |
The time frames for filing all other claims follow the established standards found here:
- EmblemHealth medical, hospital, and ancillary claims.
- Dental claims (pdf).
- Behavioral health claims (pdf).
We encourage you to share this flyer, Keep Your Bottom Line Healthy: Avoid Claims Timely Filing Denials and Common Billing Pitfalls, with your billing staff.