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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.

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Receipt Reports confirm timely filing for electronic claims

Receipt Reports confirm timely filing for electronic claims
Our goal is to give you accurate claims processing results and prompt payments. You can help us meet this goal by making sure all claims are completed in full with accurate information, and are received by Empire within the claim filing limits specified in your provider contract. We’ll have to deny claims that are received outside of the timely filing guidelines. 
Review EMC Receipt Reports after electronic transmission
To make sure we receive and consider electronic claims for processing within the timely filing limits, you’ll want to review your EMC Receipt Report after each electronic transmission. The EMC Receipt Report is your confirmation of timely filing of electronic claims to Empire. EMC Receipt Reports are usually available to review within 24 to 48 hours after transmission to the submitter’s electronic mailbox. The EMC Receipt Report provides a summary of all claims that are accepted, rejected and contain errors. 
Accepted claims are passed to our internal claims processing system(s) for consideration. Rejected claims within the file appear individually on the report with the reject reason for you to correct. To be considered for further processing, claims with errors must first be corrected and then refiled electronically. 
Vendor or direct submissions — you’ll still receive a Receipt Report
If you file claims electronically via a clearinghouse and/or EDI vendor, you may receive reformatted Empire reports and you’ll want to work with the vendors to make sure they have access to the Empire EMC Receipt Reports. If you submit claims directly to Empire and aren’t receiving EMC Receipt Reports in your e-mail, please contact our EDI Help Desk for technical assistance by calling 866-889-7322. You’re responsible for archiving reports in case you need to show proof of timely filing. 
FEP claims with other carrier codes of 02(Medicare & Workers Comp), 04(Medicare & COB),10 (Medicare & no Fault), 11(Government Programs savings) or 17(Medicare & Blue/Blue) are excluded from the provider and contractual timely filing guidelines. 
Appealing a timely filing decision
If a claim is denied due to lack of timely submission, you can request an appeal by calling the provider inquiry phone number on the member’s ID card. 
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