Claim Timely Filing Job Aid
Table of Contents
Claim Timely Filing Job Aid
Reimbursement may not be made under Medicare Part A, Part B or DME for services provided to a beneficiary if the claim is not submitted within the filing time limit. Costs for these claims are the responsibility of the provider. Beneficiaries cannot be billed for provider-liable charges.
The PPACA amended the time period for filing Medicare FFS claims. Under the new law, claims for services furnished on or after1/1/2010 must be filed within one calendar year after the date of service.
Utilize our Claim Timely Filing Calculator to determine the timely filing limit for your service.
Timely Filing Limits
- Claims for services furnished on or after 1/1/2010 must be filed within one calendar year after the date of service.
- Claims for services furnished before 1/1/2010 must be filed no later than 12/31/2010.
Date of Service Considerations
- Claims for services that require the reporting of a line item date of service, the line item date is used to determine the date of service. For other claims, the claim statement’s “From” date is used to determine the date of service (this includes supplies and rental items).
- Note: If a line item “From” date is not timely, but the “To” date is timely, Medicare contractors will split the line item and deny untimely services as not timely filed.
- Institutional claims that include span dates of service (i.e., a “From” and “Through” date span on the claim), use the “Through” date on the claim to determine the date of service for claims filing timeliness.
- Leap year claims that have a date of service of February 29th must be filed by February 28th of the following year to be considered filed timely.
Timely Filing Limits Chart
| Claims with Services Rendered | Must be Submitted By |
|---|---|
| 10/1/2008–9/30/2009 | 12/31/2010 |
| 10/1/2009–12/31/2009 | 12/31/2010 |
| 1/1/2010 and forward | One calendar year from the date of service |
Timely Filing Exceptions
- Administrative error – if failure to meet the filing deadline was caused by error or misrepresentation of an employee, Medicare contractor, or agent of the department that was performing Medicare functions and acting within the scope of its authority
- Retroactive Medicare entitlement – a beneficiary receives notification of Medicare entitlement retroactive to or before the date the service was furnished
- Retroactive Medicare entitlement involving state Medicaid agencies – a state Medicaid agency recoups payment from a provider or supplier six months or more after the date the service was furnished to a dually eligible beneficiary
- Retroactive disenrollment from a MA plan or PACE provider organization – a beneficiary was enrolled in an MA plan or PACE provider organization, but later was disenrolled from the MA plan or PACE provider organization retroactive to or before the date the service was furnished, and the MA plan or PACE provider organization recoups its payment from a provider or supplier six months or more after the date the service was furnished