Medicaid claim submission time limit - primary and secondary claims

Timely Claim Submission
Medicaid providers should submit claims immediately after providing services so
that any problems with a claim can be corrected and the claim resubmitted
before the filing deadline.

Clean Claim 

In order for a claim to be paid, it must be a clean claim. A clean claim is a
Medicaid claim that:
·  Has been accurately and fully completed according to Medicaid billing guidelines.
·  Is accompanied by all necessary documentation.
·  Can be processed and adjudicated by the fiscal agent without obtaining
additional information from the provider.


12-Month Filing Limit
A clean claim for services rendered must be received by the Medicaid office or
its fiscal agent no later than 12 months from the date of service.

Date Received Determined


The date stamped on the claim by any Medicaid office or by the Medicaid fiscal
agent is the recorded date of receipt for a paper claim. The fiscal agent date
stamps the claim the date that it is received in the fiscal agent’s mailroom.
The date electronically coded on the provider’s electronic transmission by the
Medicaid fiscal agent is the recorded date of receipt for an electronic claim.


Third Party Payer and Medicare Insurance Claims
Claims for recipients who have Medicare or other insurance must be submitted
to a third party payer prior to sending the claim to Medicaid.

For non-Medicare claims, the claim must be received by Medicaid or the
Medicaid fiscal agent no later than 12 months from the date of service or six
months from the date of the other insurance payment or denial.

The filing limit for Medicare claims crossing over to Medicaid is the greater of 36
months from the date of discharge or 12 months from Medicare’s adjudication
date.

2 comments:

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