Last Modified: 12/15/2017 Location: FL, PR, USVI Business: Part A, Part B
Claims timely filing guidelines FAQ
Q: What are the claims timely filing guidelines? How can I prevent claim denials and/or rejects for untimely filing?
A: Per Section 6404 of the Patient Protection and Affordable Care Act (ACA), Medicare fee-for-service (FFS) claims for services furnished on or after January 1, 2010, must be filed within one calendar year from the date of service. Claims with dates of service January 1, 2010, and later, received more than one calendar year (12 months) from the date of service will be denied or rejected.
Key points to remember
For all claims:
• Claims with a date of service of February 29 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 of when the claims are 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 date of service for claim timely filing.
• Part B claims – “From date” is used to determine the date of service for claim timely filing.
Exceptions allowing extension of time limit:
• Exceptions to the 12-month timely filing period are 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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