Provider Notice Issued 03/19/2021

 

Date:   March 19, 2021

 

To:       All Medical Assistance Program Providers

 

Re:      Resumption of Timely Filing Editing May 1, 2021

 

 

This notice informs providers that the Department will resume editing for timely filing beginning with claims received May 1, 2021. This information applies only to claims for participants covered under traditional Medicaid fee-for-service, as well as claim information uploaded through the HFS COVID uninsured testing portal in accordance with the February 2, 2021 provider notice.

 

As a result of the current COVID-19 public health emergency (PHE), the Department had requested a waiver in early 2020 through the federal Centers for Medicare & Medicaid Services (CMS) to temporarily suspend the one-year timely filing requirement. This waiver request was ultimately denied by CMS. With federal regulations for timely filing being one year from date of service, the Department was only able to suspend the G55 edit required by State law (Public Act 97-0689), which rejects claims greater than 180 days but less than 365 days from date of service.

 

180-Day Timely Filing

The March 20, 2020 provider notice stated that the Department planned to extend the 180-day timely filing limit to two months from the end date of the public health emergency. As the PHE declaration continued through 2020 and remains in place, the Department is amending that earlier plan. The Department will resume 180-day timely filing editing effective with claims received beginning May 1, 2021.

 

One-Year Timely Filing

As there was a delay in implementing the HFS COVID uninsured testing portal, the Department will temporarily lift the one-year timely filing deadline to allow providers sufficient time to submit claims that had been held. Providers should prioritize the most aged claims for submittal. The Department will resume one-year timely filing editing effective with claims received beginning May 1, 2021.

 

Long term care questions regarding this notice may be directed to the Bureau of Long Term Care at 844-528-8444. All other questions may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

 

 

 

Kelly Cunningham, Administrator

Division of Medical Programs​


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