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Claims Filing Deadlines

Claims submitted directly to SelectHealth for payment to a provider must be submitted to SelectHealth on UB-92/04 or HCFA 1500 claim forms within 12 months of the date of service. Claims received by SelectHealth more than 12 months after the date of service will be denied unless the provider can show that notice was given or proof of loss was filed as soon as reasonably possible.

Coordination of Benefits (COB) payments, when SelectHealth is the secondary payer, will be made only if the information supporting the payment is submitted to SelectHealth within 12 months after the claim was processed by the primary plan, unless the provider shows that the information was supplied or proof of loss was filed as soon as reasonably possible.

As of May 12, 2009, the Utah Insurance Department’s COB rule changed the filing deadline to the correct primary plan in a COB situation. If a claim is filed to the wrong primary insurer, the claim can be re-filed to the appropriate primary plan within 24 months of the date of service without penalty. According to the State’s COB rule, "A primary plan may not deny payment or a benefit on the grounds that a claim was not timely submitted if the claim was timely submitted to one or more secondary plans and was submitted to the primary plan within 24 months of the date of service."
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