What is timely filing to adjust a claim?
CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34 – Reopening and Revision of Claim Determinations and Decisions, Section 10.6.2 offers the following protocol for filing an appeal.
A party may request a contractor reopen and revise its initial determination or redetermination under the following conditions:
- Within one year from the date of the initial determination or redetermination for any reason; or
- Within four years from the date of the initial determination or redetermination for good cause as defined in Section 10.11; or,
- At any time if the initial determination is unfavorable, in whole or in part, to the party thereto, but only for the purpose of correcting a clerical error on which that determination was based.
Third party payer error does not constitute clerical error as defined in Section 10.4.