A contracted provider has the responsibility to file the claim within 12 months from the date of service. Claims denied for untimely filing are not the member’s responsibility, unless one of the following exceptions is met:
When a non-contracted provider is used, it is the responsibility of the member to ensure that the claim is filed promptly and properly. Claims that are not received within 12 months from the date of service will be denied. The member will be responsible for the entire claim.
If a provider disputes the date a claim was recieved, PEHP will only accept the following as proof of timely filing: