Last Modified: 10/4/2018 Location: FL, PR, USVI Business: Part A, Part B
Claims timely filing guidelines FAQ
Q: What are the claim timely filing guidelines? How can I prevent claim denials and/or rejects for untimely filing?
A: Claims for services rendered on or after January 1, 2010, must be filed with the appropriate Medicare claims processing contractor no later than 12 months, or one calendar year, after the date of service (DOS). Claims submitted after one calendar year from the DOS will be denied or rejected.
Key points to prevent this denial
For all claims:
• Claims with a February 29 DOS must be filed by February 28 of the following year to be considered filed timely.
• Electronic claims -- The electronic data interchange (EDI) system accepts claims 24/7; however, claims received after 6 p.m. eastern time (ET) or on a weekend or holiday are considered received the next business day.
• Paper claims -- Timeliness is calculated based on contractor receipt date, not the postmark date when the claim was mailed, so please allow time for mailing.
For claims with “span dates of service” (“from” and “through” date span on the claim):
• Part A institutional claims – “Through date” is used to determine the DOS for claim timely filing.
• Part B claims – “From date” is used to determine the DOS for claim timely filing.
Exceptions allowing extension of time limit:
• Exceptions to the 12-month timely filing period are limited and very specific as outlined in the Centers for Medicare & Medicaid Services (CMS) internet-only manual (IOM) Medicare Claims Processing Manual, Chapter 1 .
• Click here to view the documentation needed to qualify for Part A exceptions.
Source: CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 1 ; Section 6404, Patient Protection and Affordable Care Act (PPACA) ; Code of Federal Regulations Title 42 CFR 424.44 - Time limits for filing claims (http://www.ecfr.gov )
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