![]() Therefore, it is imperative to check the daily Rejection Report from your clearinghouse for any claims that may not have been accepted by your clearinghouse, Cigna-HealthSpring’s clearinghouse or Cigna-HealthSpring. ![]() ** When using EDI, your claims may be sent to your clearinghouse, but may NOT have been received by Cigna-HealthSpring. Claims submitted to Cigna-HealthSpring after these time limits will not be considered for payment. ** NOTE: Billing system print screens are NOT ACCEPTED for proof of timely filing. The denial MUST BE SUBMITTED along with the claim for payment consideration. ** INITIALLY FILED TO INCORRECT CARRIER – must be received at CignaHealthSpring within 120 days from the date of the denial on the incorrect Carrier’s EOB/RA (as long as the claim was initially filed to that carrier within 120 days of the date of service). These claims must be clearly marked “CORRECTED” in pen or with a stamp directly on the claim form. ** CORRECTED CLAIMS – must be received at Cigna-HealthSpring within180 days from the date on the initial Cigna-HealthSpring Remittance Advice. ** SECONDARY FILING – must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier’s EOB. ** INITIAL CLAIM – must be received at Cigna-HealthSpring within 120 days from the date of service. To ensure your claims are processed in a timely manner, please adhere to the following policies: Do not send your request to WPS Medicare using the Redetermination Form. WPS Medicare Redeterminations unit cannot grant any waiver to timely filing deadline after the claim probably was processed, since claims denied for timely filing do not have appeal rights. In rare cases, CMS permits Medicare contractors to extend time limit for filing a claim beyond the usual deadline if provider may show good cause for delay in filing the claim. As a result, in such situations, providers must file the claim promptly after error was probably corrected. CMS indicates that Medicare contractors could determine good cause exists when an administrative error on an official part Medicare employee acting on Medicare behalf contractor within scope of his/her authority caused the delay. There have probably been no appeal rights on denied claim. Circumstances such as backdated Medicare entitlement may as well qualify for a timely extension filing deadline. The claim form should have the words “see attachment” in the “Member ID” box.The following is important information regarding recent New York State Managed CareĮffective April 1, 2010, New York State Managed Care regulations stipulate that health careĬlaims must be submitted by health care providers within 120 days of the date of serviceĬenters for Medicare Medicaid maintenance requires Medicare contractors to deny claims submitted after timely file limit is expired. Physicians and health care providers may submit CMS 1500 forms or UB04 forms with an attachment listing multiple patients receiving the same service. Physicians and health care providers may submit multiple documents in a single large envelope.ĭocuments may include information regarding multiple patients. Physicians and other health care providers should follow the billing guidelines below when submitting roster bills to Humana: ![]() When a claim is submitted in error to a carrier or agency other than Humana, the timely filing period begins as of the date the provider was notified of the error by the other carrier or agency.īilling guidelines for roster bills submitted on paper claims Generally, these claims must be submitted within:ġ80 days from the date of service for physicians.ĩ0 days from the date of service for facilities and ancillary providers. Medicare Advantage: Claims must be submitted within one calendar year from the date of service.Ĭommercial: Claims must be submitted within the time stipulated in the provider agreement or the applicable state law. Health care providers are encouraged to take note of the following claims submission time frames: Paper claim and encounter submission addresses Valid National Provider Identifiers (NPIs) are required on all electronic claims and strongly encouraged on paper claims. Please keep in mind, however, that the claim or encounter mailing address on the member’s identification card is always the most appropriate to use. When it is necessary to submit paper claims, you can use the addresses below. To decrease administrative costs and improve cash flow, clinicians and facilities are encouraged to use electronic claim submission whenever possible.
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