Timely Filing

As a result of the Patient Protection and Affordable Care Act (PPACA), all claims for services furnished on/after January 1, 2010, must be filed with your Medicare Administrative Contractor (MAC) no later than one calendar year (12 months) from the date of service (DOS) or Medicare will deny the claim.

  • In general, start date for determining 1-year timely filing period is DOS or "From" date on claim
    • Claims with a February 29 DOS must be filed by February 28 of following year to meet timely filing requirements
  • For institutional claims that include span DOS (i.e., a "From" and "Through" date on claim), "Through" date on claim is used for determining DOS for claims filing timeliness
  • For claims submitted by physicians and other suppliers that include span DOS, line item "From" date is used for determining date of service for claims filing timeliness

Resources

  • CMS Medicare Learning Network (MLN) Matters (MM)6960 - Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months
  • CMS MM7080 - Timely Claims Filing: Additional Instructions
  • CMS MM7270 - Changes to the Time Limits for Filing Medicare Fee-for-Service Claims
  • CMS MM7834 - Modifying the Timely Filing Exceptions on Retroactive Medicare Entitlement and Retroactive Medicare Entitlement Involving State Medicaid Agencies
  • CMS MM8581 - Automation of the Request for Reopening Claims Process
  • CMS SE1426 - Scenarios and Coding Instructions for Submitting Requests to Reopen Claims that are Beyond the Claim Filing Timeframes - Companion Information to MM8581: "Automation of the Request for Reopening Claims Process"

 

Last Updated Wed, 11 Nov 2020 13:43:09 +0000

Claim Submission Timeliness Calculator


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