Starting Sept. 1, 2023, providers will be required to submit claims for EmblemHealth members who are part of the Local 389 Health and Welfare Fund within 90 days of the date of service. This time frame applies to new in- and out-of-network medical claims (professional, hospital, and other facility claims).
EmblemHealth’s self-funded groups (also called administrative service organization clients or “ASO clients”) may set specific plan claim filing limits which supersede those that apply to other members. Below are the EmblemHealth ASO clients’ specific plan timely filing limits:
| Group | Plan Type | In-Network Limit | Out-of-Network Limit |
|---|---|---|---|
Local 389 Health and Welfare Fund (effective 9/1/2023) |
Medical | 90 days | 90 days |
| 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:
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.
JP 62865 08/2023