Provider Notice issued 03/22/13

Clarification regarding 180 Day Time Limits for Claim Submittal

To:​ Participating Medical Assistance Providers​
Date:​ March 22, 2013​
Re:​ Clarification regarding 180 Day Time Limits for Claim Submittal​

The purpose of this notice is to provide clarification to the July 23, 2012, informational notice, 180 Day Time Limits for Claim Submittal  regarding time limits for claim submittal.

Effective July 1, 2012, the department changed the timely submittal of claims policy from 12 months to 180 days. The July 23, 2012, notice erroneously stated that the 180 day timely submittal was based on the date the claim was received by the department. The 180 day policy begins from the date on which services or items are provided. This time limit applies to both initial and resubmitted claims. Rebilled claims, as well as initial claims, received more than 180 days from the date of service will not be paid.

In addition, the department has clarified that for hospital inpatient and outpatient claims, the 180 days begins from the through date of service.

The new error code message that providers will receive for claims exceeding the above time limit is G55- 180 Day Timely Filing.

The 180 day timely submittal of claims for pharmacies was not implemented until January 1, 2013.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs