Top Provider Questions – Timely Filing
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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 institutional claims must be submitted within one year of the "Through" the date of service to meet the timely filing guideline.
Reviewed 02/11/2022
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- Do Medicare replacement plans (Medicare Advantage (MA)) generally follow Medicare timely filing guidelines?
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As a Medicare Administrative Contractor (MAC), we are not able to provide guidance related to MA plan requirements. Please contact the individual MA plan.
Reviewed 02/11/2022
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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. However, if a claim rejects because another insurance is primary, an exception may be applied if an adjustment claim (XX7) is submitted within one year of the date of the initial rejection. In these cases, a Reopening request must be submitted along with supporting documentation.
Reviewed 02/11/2022
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- My claim was rejected with reason code 39011 because it was not submitted timely. What can I do to get Medicare to pay my claim?
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The Centers for Medicare & Medicaid Services (CMS) regulations require that claims be submitted no later than 12 months, or 1 calendar year, after the date of services furnished. However, Medicare regulations allow for some exceptions. Refer to the Medicare Claims Processing Manual, CMS Pub. 100-04, Ch. 1, §70.7 for more information about the exceptions.
Reviewed 02/11/2022
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