Get the free excellus timely filing form

REQUEST FOR TIMELY FILING REVIEW We will consider circumstances beyond a providers or member\'s control that resulted in delayed submission of claims on a casebycase basis. Please use this form to

How to fill out excellus timely filing form

How to fill out excellus timely filing form:

1. Gather the necessary information: Before starting to fill out the form, gather all the required information such as patient details, provider details, dates of service, and any supporting documentation.
2. Download the form: Visit the Excellus website or contact their customer service to download the timely filing form. Ensure that you have the latest version of the form to avoid any discrepancies.
3. Fill in patient information: Start by filling out the patient's name, date of birth, Excellus ID number, and any other relevant information requested on the form. Double-check the accuracy of the information provided to prevent any delays or rejections.
4. Provide provider details: Next, include the name, address, and contact information of the healthcare provider who rendered the services. Make sure to enter the correct provider's National Provider Identifier (NPI) number to avoid any processing issues.
5. Specify dates of service: Indicate the dates of service for which the claim is being submitted. Mention the beginning and ending dates of treatment or the duration in which the services were provided.
6. Attach supporting documents: If there are any supporting documents required to accompany the claim, make sure to attach them securely. These documents may include medical records, itemized bills, or any other relevant information that supports the services rendered.
7. Review and double-check: Before submitting the form, thoroughly review all the information provided. Ensure that all fields are properly filled in and that there are no errors or omissions. The accuracy of the information submitted is crucial for timely processing of the claim.

Who needs excellus timely filing form:

1. Patients with health insurance: The Excellus timely filing form is typically required for patients who are covered by Excellus health insurance. It is important for these patients to submit this form within the designated time frame to ensure that their claims are reviewed and processed in a timely manner.
2. Healthcare providers: Healthcare providers who have rendered services to patients covered by Excellus insurance may need to submit the timely filing form. This form allows them to request reimbursement for the services provided within the specified time limits set by Excellus.
3. Providers with outstanding claims: Providers who have outstanding claims and need to file them within the specified time frame may also require the Excellus timely filing form. This form serves as a means of documenting and submitting these claims to Excellus for reimbursement.

In conclusion, filling out the Excellus timely filing form requires gathering necessary information, downloading the form, providing patient and provider details, specifying dates of service, attaching supporting documents, and reviewing the form for accuracy. This form is typically needed by patients with Excellus insurance and healthcare providers who need to submit or request reimbursement for services within the designated time frame.

For pdfFiller’s FAQs

What is excellus timely filing form?

The excellus timely filing form is a document that healthcare providers submit to Excellus BlueCross BlueShield to request reimbursement for services provided.

Who is required to file excellus timely filing form?

Healthcare providers who have rendered services to Excellus BlueCross BlueShield members are required to file the timely filing form.

How to fill out excellus timely filing form?

Healthcare providers must fill out the form with details of the services provided, including patient information, date of service, codes, and charges.

What is the purpose of excellus timely filing form?

The purpose of the timely filing form is to request reimbursement for services provided to Excellus BlueCross BlueShield members in a timely manner.

What information must be reported on excellus timely filing form?

The form must include patient information, date of service, codes for the services provided, charges, and any other relevant details.

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