Providers are expected to take appropriate and reasonable action to identify Health First Colorado eligibility in a timely manner. What if the member did not notify the provider of eligibility?
UHC TIMELY FILING LIMIT 2020 SOFTWARE
If the issue is between the provider and the software vendor, billing agent or clearinghouse, this does not constitute an acceptable reason to be outside the timely filing period. What if the issue was with my vendor? Issues resulting in failure to transmit accurate and acceptable claims or failure to identify transmission errors in a timely manner must be addressed. The claim must be submitted, even if the result is a denial. Phone calls and other correspondence are not proof of timely filing. What if I contacted the Department or fiscal agent and I am still waiting for a response? Waiting for prior authorization or correspondence from the Department or the fiscal agent is not an acceptable reason for late filing. If there is an RA within the last 60 days, providers must reference the previous ICN. Can I attach a copy of my Remittance Advice (RA) as a timely extension? No. The fiscal agent does not accept attachments via batch submissions. Attachments should be submitted with the claim via the Provider Web Portal. Providers must enroll and submit claims within 365 days from the DOS.Ĭlaims that are not able to be submitted within the 365-day guideline, but have one (1) of the above documents attached to the submission will be put into suspended status and will be reviewed by the fiscal agent. A backdate approval letter (new enrollments, affiliations or updates are not acceptable reasons for late filing).Claims that have been date-stamped by the fiscal agent or the Department and returned to the provider.The following are examples of acceptable proof of timely filing: If any of the scenarios listed below apply, but the claim in question is still within the 365-day window, a waiver is not needed and the provider only needs to resubmit the claim. How can a provider qualify for a timely waiver (override)? The previous ICN must be referenced on the claim, even if the claim is over 365 days. Providers must also resubmit claims every 60 days after the initial timely filing period (365 days from the DOS) to keep the claim within the timely filing period. What should providers do if the initial 365-day window for timely filing is expiring? Providers are required to submit the initial claim within 365 days, even if the result is a denial. What date is used when considering timely filing deadlines? A claim is considered filed when the fiscal agent documents receipt of the claim. A timely filing waiver or a previous Internal Control Number (ICN) is required if a claim is submitted beyond the 365-day timely filing period. Providers always have at least 365 days from the DOS to submit a claim. This is a permanent change, not a temporary extension. What is the deadline for meeting timely filing requirements? Effective June 1, 2018, the Department of Health Care Policy & Financing (the Department) extended the timely filing period to 365 days from the date of service (DOS).
0 kommentar(er)
