![]() The loss of reimbursement for claims due to timely filing errors can be significant, and while some payers may allow an appeal, some are becoming very strict about the rules for overturning a timely filing denial. In short, be sure to review all MA plan contracts or speak with an MA plan representative to be certain of the timely filing dates and educate all staff who may be involved with patient documentation and claims. Providers should check with the individual MA Plan to determine their timely claim filing requirements. "Question: Do Medicare replacement plans (Medicare Advantage (MA) Plans) generally follow Medicare guidelines for timely filing?Īnswer: We do not know about the timely filing guidelines for MA Plans. Upon review of a CGS Medicare FAQ on timely filing for Medicare Advantage plans, the following question and answer was received, They state this change is done in an effort to, " simplify our processes, align with industry standards, and better support coordination of care." Some providers and/or coding and billing staff may be unaware that, although the original or traditional Medicare Fee For Service plan has a one-year timely filing rule, patients who transfer their Medicare benefits over and join a Medicare Advantage Plan are required to follow the timely filing rules for their particular MA plan and most often, that filing requirement is significantly shorter than one year.Īs an example, on June 21, 2019, Anthem Blue Cross sent a notification to their network and contracted providers informing them that their new timely filing rule will become effective as of October 1, 2019, and the time for submitting a claim will be limited to 90 days from the date of service. ![]()
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