What is timely filing for medicare

what is timely filing for medicare

TIMELY FILING GUIDELINES

In order to be reimbursed for services rendered, all providers must comply with the following filing limits set by Louisiana Medicaid:

Straight Medicaid claims must be filed within 12 months of the date of service.

KIDMED claims must be filed within 60 days from the date of service.

Claims for recipients who have Medicare and Medicaid coverage must be filed with the Medicare fiscal intermediary within 12 months of the date of service in order to meet Medicaid's timely filing regulations.

Claims which fail to cross over via tape and have to be filed hard copy MUST be filed within six months after the date on the Medicare Explanation of Medicare Benefits (EOMB), provided that they were filed with Medicare within one year from the date of service.

Claims with third-party payment must be filed to Medicaid within 12 months of the date of service.

Dates of Service Past Initial Filing Limit

Medicaid claims received after the initial timely filing limits cannot be processed unless the provider is able to furnish proof of timely filing. Such proof may include the following:

A Remittance Advice indicating that the claim was processed earlier (within the specified time frame)

Correspondence from either the state or parish Office of Eligibility Determination concerning the claim and/or the eligibility of the recipient.

To ensure accurate processing when resubmitting the claim and documentation, providers must be certain that the claim is legible. Proof of timely filing documentation must reference the individual recipient and date of service.

At this time Louisiana Medicaid does not accept printouts of Medicaid electronic remittance advice screens as proof of timely filing. Documentation must reference the individual recipient and date of service. Postal "certified" receipts and receipts from other delivery carriers are not acceptable proof of timely filing.

Dates of Service Over Two Years Old

Claims with dates of service over two years old are not to be submitted to Molina Medicaid Solutions or to the BHSF for overriding of the timely filing edit unless one or more of the guidelines listed below is met:

The recipient was certified for retroactive Medicaid benefits.

The recipient won a Medicare or Social Security Information appeal in which he was granted retroactive Medicaid benefits, and/or;

The failure of the claim to pay was the state's, rather than the provider's fault each time the claim was adjudicated.

Source: www.lamedicaid.com

Category: Insurance

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