![]() ![]() ![]() It is not based on the date the claim was sent or received. VIVA HEALTH Claims: PO Box 55926 Birmingham, AL 35255. The claims filing deadline is based on the date of service on the claim. proof of timely filing, or the other carriers Explanation of Payment. Health Plan within the previously stated timely filing limits. New Jersey - 90 or 180 days if submitted by a New Jersey participating health care provider for a New Jersey line of business member. ![]() The beneficiary is charged utilization days, if applicable for the type of services received. Tufts Medicare Preferred HMO and Tufts Health Plan SCO will consider payment disputes and. In appropriate cases, such claims should be processed because of the spell-of-illness implications and/or in order to record the days, visits, cash and blood deductibles. Where the beneficiary request for payment was filed timely (or would have been filed the request timely had the provider taken action to obtain a request from the patient whom the provider knew or had reason to believe might be a beneficiary) but the provider is responsible for not filing a timely claim, the provider may not charge the beneficiary for the services except for such deductible and/or coinsurance amounts as would have been appropriate if Medicare payment had been made. If a claim is returned to the provider for additional information, the claim must be resubmitted before the timely filing period expires. As such, the determination that a claim was not filed timely is not subject to appeal. When a claim is denied for having been filed after the timely filing period, such denial does not constitute an “initial determination”. Medicare denies a claim for untimely filing if the receipt date applied to the claim exceeds 12 months or 1 calendar year from the date the services were furnished (i.e., generally, the “From” date, with the exception of the “Through” date for institutional claims that have span dates of services, as specified in §70.1). 240 - Time Limits for Filing Appeals & Good Cause for Extension of the Time Limit for Filing Appeals 240.1 - Good Cause 240.2 - Conditions and Examples That May Establish Good Cause for Late Filing by Beneficiaries 240. (ii) If a claim for payment under Medicare has been filed in a timely manner, the agency may pay a Medicaid claim relating to the same services within 6. Medicare document says yes but only limited to Deductible and coins.ĭetermination of Untimely Filing and Resulting Actions The Patient Protection and Affordable Care Act requires that Medicare and Medicaid overpayments be reported and returned within 60 days after they are. ![]()
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