Last Modified: 2/6/2021
Location: FL, PR, USVI
Business: Part A, Part B
Q: What are the claim timely filing guidelines? How can I prevent claim denials and/or rejects for untimely filing?
A: Per Medicare guidelines, claims must be filed with the appropriate Medicare claims processing contractor no later than 12 months (one calendar year) after the date of service (DOS). Claims must be processed (paid or denied/rejected) by Medicare in order to be considered filed/submitted. Claims with missing, invalid or incomplete information that prevents Medicare from processing them, also known as “returned to provider/RTPs” (Part A) and “return unprocessable claims/RUCs” (Part B), are NOT considered filed/submitted. RUCs and RTPs must be corrected and resubmitted for processing. Claims submitted after one calendar year from the DOS will be denied or rejected.
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. 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 CMS internet-only manual (IOM) Medicare Claims Processing Manual, Chapter 1
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.