Tuesday, July 6, 2010

Commercial insurance time limit to submit claims

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  Remittance Advice

The Program will not accept computer-generated reports form 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.

Electronic Claims Submission: Providers must submit claims in the ANSI ASC X12N 837P
format, version 4010A. A signed Submitter Identification Form and Trading Partner Agreement
must be submitted, as well as testing before transmitting such claims.

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