June 22, 2020
As a result of the National Emergency declared on March 1, 2020, the Employee Benefits Security Administration, Department of Labor, Internal Revenue Service and the Department of the Treasury extended certain timeframes to ease the burden of maintaining benefits and compliance with notice obligations. Blue Cross and Blue Shield of Texas (BCBSTX) will follow these guidelines .
This is for members of all fully insured and self-funded groups that are regulated by the Employee Retirement Income Security Act (ERISA).
What does this mean?
In compliance with the guidelines, between March 1, 2020 and 60 days after the announced end of the National Emergency, the following periods and dates are suspended:
- The date within which individuals may file a claim
- The date within which claimants may file an appeal of adverse benefit determination
- The date within which claimants may file a request for external review after receiving an adverse determination
Timely Filing Rule
To help providers and individuals meet timely filing rules, the period from March 1, 2020 to 60 days after the announced end of the National Emergency will not count towards timely filing requirements.
Situation (assume 180-day timely filing rule) – The time for a claim to fulfill the timely file rule expired on Feb. 29, 2020
Outcome – The rules to suspend timely filing do not apply. If we receive the claim after Feb. 29, the claim is subject to denial.
Situation (assume 180-day timely filing rule) – Service was rendered on Sept. 2, 2019. The claim entered day 179 of the 180-day timeline on Feb. 29, 2020.
Outcome – The time to file this claim is suspended starting on March 1, 2020, until 60 days after the National Emergency is declared over. If the National Emergency were over on June 1, 2020, 60 days later is July 31, 2020. On July 31, one day remains to file the claim.
Situation (assume 180-day timely filing rule) – The date of service was March 1, 2020
Outcome – If the National Emergency were over on June 1, 2020, the 180-day timeline to file this claim would start 60 days later, on July 31. The claim would be due before Jan. 27, 2021.
Appeals of Adverse Benefit Determination
The 180-day timeline for appealing an adverse benefit determination on a claim has been suspended as well. In compliance with the guidelines, the period from March 1, 2020 to 60 days after the announced end of the National Emergency will not count towards the deadline to submit an appeal. Until further notice, we will accept as timely all valid appeals of adverse benefit notifications dated on or after Sept. 3, 2019.
Situation – The adverse decision is received by the claimant on June 1, 2019. The claimant files an appeal on March 24, 2020.
Outcome – The rules to suspend the timeline for appealing a decision do not apply because the appeal should have been filed by Nov. 28, 2019. Because the timeline for appealing expired before the effective date of these DOL guidelines, the normal timeframes apply and the appeal submitted on March 24, 2020 is not timely.
Situation – The adverse decision is received by the claimant on Sept. 3, 2019. The end of the 180-day timeline is March 1, 2020.
Outcome – The claimant has until the end of the National Emergency, plus 60 days to file the appeal.
Request for External Review
The timeline to file a request for an external review will be suspended. In compliance with the guidelines, the period from March 1, 2020, to 60 days after the announced end of the National Emergency will not count towards the deadline to request an external review. External review application timelines may vary by state, product and employer groups. Members should follow the instructions received in the appeal decision notification to initiate an external review.
We appreciate your cooperation as we update our systems and processes to comply with the latest rules. Call the number on our members’ ID card or your BCBSTX representative with questions.