Timely Filing FAQs
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- What are the timely filing guidelines for Medicare claims?
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Medicare timely filing guidelines can be found in the Medicare Claims Processing Manual (Pub. 100-04, Ch. 1, §70
). Medicare claims must be submitted within one year from the date of service.For home health and hospice claims the "Through" date on the claim is used for determining the date of service for claims filing timeliness. See the Timely Claim Filing Requirements Web page for additional information.
Reviewed: 03.08.17
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- Our agency's policy is that if a claim is pulled for an Additional Development Request (ADR), we wait until the claim is finalized before sending the next claim. If we go through the appeals process, that may take some time. This is compounded if a subsequent claim is also ADRd. We are worried about the impact of timely filing in this situation.
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In most cases, CGS does not recommend submitting a subsequent claim while the prior claim is still suspended. However, when a prior claim is in the Additional Development Request (ADR) status/location of S B6001, providers may continue to submit subsequent claims, while the prior claim is being reviewed. This will help ensure that timely filing of subsequent claims is not jeopardized. Any subsequent claims billed will suspend until the ADR'd claim has been reviewed and released for processing. Going through the appeals process does not affect sequential billing since the claim being appealed is a finalized claim.
Reviewed: 03.08.17
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- Do Medicare replacement plans (Medicare Advantage (MA) Plans) generally follow Medicare guidelines for timely filing?
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We do not know about the timely filing guidelines for MA Plans. Providers should check with the individual MA Plan to determine their timely claim filing requirements.
Reviewed: 03.08.17
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- How are Medicare Secondary Payer (MSP) claims handled by Medicare with respect to the timely filing requirements? If a claim is billed with Medicare as primary, and rejects because another insurance is primary, has the claim met the timely filing requirements?
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All Medicare claims, including adjustments, are subject to timely filing. See the Timely Claim Filing Requirements Web page for additional information. However, if a claim was rejected because another insurance is primary, an exception may be applied if an adjustment claim (XX7) is submitted within one year of the date the initial claim was rejected. In these cases, a Reopening request must be submitted, along with supporting documentation. Refer to the Reopening webpage for additional information.
Reviewed: 03.08.17
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