![]() Therefore, the last day to submit a claim is 365 days after June 29, 2020, which is June 29, 2021.Īlso, based on the same assumptions, if an individual received a notification of an adverse benefit determination from his disability plan on January 28, 2020, which notified him that there were 180 days within which to file an appeal, the employee’s appeal deadline would be determined by disregarding the outbreak period. To determine the 365-day period applicable to the claim, the outbreak period is disregarded. Thus, if an employee received medical treatment on March 1, 2020, but did not submit a claim relating to the medical treatment until April 1, 2021, and the plan required that claims be submitted within 365 days of the receipt of the medical treatment, this participant’s request would be considered timely submitted. Other deadlines that apply for perfecting an incomplete request for review are also extended.įor example, if the COVID-19 national emergency had ended on April 30, 2020, the disregarded outbreak period would have ended 60 days later, on June 29. And deadlines have been extended for requesting external review following exhaustion of the plan’s internal appeals procedures. The extension permits the “outbreak period”-beginning March 1, 2020, and ending 60 days after the announced end of the COVID-19 emergency-to be disregarded for specified purposes related to claims.Īffected timeframes include the deadlines for individuals to notify the plan of a qualifying event or determination of disability, to file claims for benefits, and to file appeals of adverse benefit determinations under ERISA plans and non-grandfathered group health plans. How long is the extension?ĪNSWER: In response to the COVID-19 emergency, federal agencies have extended certain claims and appeals time periods for group health plans (as well as disability and other employee welfare benefit plans, and employee pension benefit plans) that are subject to ERISA or the Code (see our Checkpoint article). Include reference numbers or authorization or any information that will help your appeal.QUESTION: We understand that we are required to extend the time periods applicable to claims and appeals under our group health plan due to the COVID-19 emergency. Say what information you received when you did the eligibility check and who you spoke with. Then you get a chance to describe why you are denying the claim. ![]() This will be the five digit number that describes what kind of session this ways (e.g. ![]() Then you will include the CPT code that you used for the claim. You will want to match this number exactly as it shows on the EOB. Then you will write the initial denial notification date, which would come from the EOB or ERA. Then you will enter the date of service or the date that you saw the patient. If you have completed a verification of benefits, you can include that number here for their reference. Then you will want to include a reference number or authorization number. This will be very important for Aetna to process the appeal This ID can be found on the EOB or explanation of benefits that you received the denial on. Be sure to enter a valid mailing address and valid phone number. Again, both numbers you will want to match the claim that was submitted.įinally, you will want to enter all of your contact information so the insurance company can get back to you if they have any questions or concerns. This includes your name (as it appears on the claim), your TIN and NPI. Then you will fill out your information and the contact information. Then you will want to enter their name exactly how it shows on the insurance ID card ![]() You will want to enter the current date, the ID number from the insurance card, select Medical and enter the group number from the patient's card. The first few boxes are definitely self-explanatory. ![]()
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