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What is the claim timely filing guideline? How can I prevent claim denials or rejects for untimely filing?

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, denied, or rejected) by Medicare to be considered filed or submitted. Claims with missing, invalid or incomplete information that prevents Medicare from processing them, also known as "returned to provider (RTPs)" (Part A) and "rejected as unprocessable claims" (Part B), are NOT considered filed or submitted. These claims must be corrected and resubmitted for processing. Claims rejected, returned or rejected as unprocessable will affect timely filing. Claims submitted after one calendar year from the DOS will be denied or rejected.

Some examples of reject and denial codes you may receive for timely filing include:

  • Part A: Reject reason code 39011
  • Part B: CO 29

Key points to prevent this denial or reject

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 IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 1, Section 70.

 

References