Timely Filing and Claim Review Timeframes

April 2022

Effective January 1, 2022, claim submission and review timeframes were updated to align with industry standards. Unless a provider’s contract states otherwise, initial claims with dates of service on/after January 1, 2022 and adjustments/reconsiderations submitted on/after January 1, 2022 have been changed to the following:

Claim/Review Stage	Submission Timeframe
Initial Claim	Complete claims must be received by Neighborhood within one hundred eighty (180) days from the date of service. For date range claim submissions, (i.e., claims that require “from”/ “to” and/or “through” dates) 180 days begins at the “to”/”through” date.
Corrected Claim	Claims must be resubmitted with all appropriate information within one hundred eighty (180) days from the date of service. For date range claim submissions, (i.e., claims that require “from”/ “to” and/or “through” dates) 180 days begins at the “to”/”through” date. In the event Neighborhood retracts payment, providers have one hundred eighty (180) days from the date on the RA regarding the retraction to submit a corrected claim, if necessary.
Adjustment Request – previously adjudicated claim	Within 60 days from the date on the initial RA. In the event Neighborhood retracts payment, providers have one hundred eighty (180) days from the date on the RA regarding the retraction to submit a corrected claim, if necessary.
Adjustment Request – timely filing	Within 60 days from the date on the other health insurer’s RA (or other proof).
Reconsideration Request	Within 60 days from either the date on the initial RA or the adverse determination of an adjustment request.

Please refer to Neighborhood’s Provider Manual for more information.

Last updated: April 6, 2022 @ 11:21 am