Description:
All South Carolina contracts, in their General Provisions Articles and under the Notice and Proof of claims paragraphs, have the following verbiage:

"Except in the absence of legal capacity, claims must be filed no later than 15 months following the date services were received."

Policy Statement:
Claims received after the legal filing deadline are to be rejected.  If the member or provider then furnishes information to the corporation to show that the claim had previously been filed and there was no record of having processed it (including a research of purged lines), such claims will be reopened.  Some examples of information can be documentation from the provider showing that the claim was filed electronically (PAID strip) or copies of correspondence from the corporation that addresses the claim in question.  Claims processors may override timely filing in these situations without obtaining supervisory approval.  If the circumstances are unclear, the supervisor should always be consulted.

If the insured was not aware that the services (i.e drug charges) were covered and charges were filed past the deadline, claims should not be reopened without supervisory approval.  In these cases, consideration should be given to the type of account (ASO vs. insured).

Cases involving facilities who did not submit charges within the timely filing periods should be referred to Provider Services.

Exception:
Some ASO accounts may elect to have timely filing requirements that differ.  Deviations from the standard requirements described in this policy should be determined by the group representatives and documented in the departmental desk procedures.

Exception:  Group and Individual Policies.  The policy and contract under the section titled, "How Long you Have to File a Claim," reads as follows:  We must receive your claim no later than 12 months from the date of service.  Exceptions may be made if you show you were not legally competent to file the claim. Claims will be processed in the order we receive them.