Timely filing:
Initial Claim: 6 months from the date of service (If HCP is primary, the claim timeliness changes to 7-months from the date of service or eligibility date).
Corrected Claim: 12 months from the date of service.
Initial Claim:6 months from date of service or PPC (If HCP is primary, the claim timeliness changes to 7-months from the date of service or eligibility date)
Corrected Claim:12 months from the date of service.
Timeliness | NON-CONTRACTED | CONTRACTED |
Claim Submissions | 6 Mos from DOS (end) | 6 Mos from DOS (end) |
Claim Re-submission | 12 Mos from DOS (end) | 12 Mos from DOS (end) |
Dispute | 60 Days from Date of Claim Determination OR 12 Mos from DOS (end) |
60 Days from Claim Determination OR 12 Mos from DOS (end) |
Second Level Dispute | 30 Calendar Days after Dispute Decision | 30 Calendar Days after Dispute Decision |