CommercialAdministrativeMedium impact
Self-Funded Plan Timely Filing Limits
EmblemHealth·Provider News
We identified it
Jun 20, 2026
Summary
EmblemHealth has updated timely filing limits for specific self-funded group plans, with BCTGM Local 53 having 180-day limits for both medical and dental claims, and NFTA Dental having 120 days in-network and 365 days out-of-network. These limits supersede standard EmblemHealth filing deadlines for these specific groups only.
Action Required
Immediately: Billing team must update claim submission workflows to identify BCTGM Local 53 and NFTA members at time of service. Configure billing system alerts to flag these specific groups and apply the correct filing deadlines: BCTGM Local 53 (180 days for medical and dental), NFTA Dental (120 days in-network, 365 days out-of-network). Train staff to verify group affiliation before claim submission to avoid timely filing denials.