Healthchoice Medicaid HMO Timely filing limit and claim submission address

BILLING INFORMATION

Providers must bill on the CMS-1500. Claims can be submitted in any quantity and at any time within the filing limitation.

Filing Statutes: Claims must be received within 12 months of the date of service. The following statutes are in addition to the initial claim submission.

12 months from the date of the IMA-81 (Notice of Retro-eligibility)

120 days from the date of the Medicare EOB

60 days from the date of Third Party Liability EOB

60 days from the date of Maryland Medicaid Remittance Advice


The Program will not accept computer-generated reports from the provider’s office as proof of timely filing. The only documentation that will be accepted is a remittance advice, Medicare/Third-party EOB, IMA-81 (letter of retro-eligibility) and/or a returned date stamped claim from the Program.


Paper Claims Submission: Once a claim has been received, it may take 30 business days to process your claim. Invoices are processed on a weekly basis. Payments are issued weekly and mailed to provider’s pay-to address. All claims should be mailed to the following address:


Claims Processing
Department of Health and Mental Hygiene
P.O Box 1935
Baltimore, MD 21203

Electronic Claims Submission: Providers must submit claims in the ANSI ASC X12N 837P format, version 5010A. A signed Submitter Identification Form and Trading Partner Agreement must be submitted, as well as testing before transmitting such claims. Testing information can be found on the DHMH website:

http://dhmh.state.maryland.gov/hipaa/SitePages/testinstruct.aspx

If you have any questions regarding HIPAA testing, please send an email to:
dhmh.hipaaeditest@maryland.gov

Companion guides to assist providers for electronic transactions can be found on the DHMH website:
http://dhmh.maryland.gov/hipaa/SitePages/transandcodessets.aspx

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