Providers

Claims

Timely filing:

NON-CONTRACTED PROVIDERS:
Initial Claim:
6 months from the date of service (If HCG 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. 
CONTRACTED PROVIDERS:
Initial Claim:
6 months from date of service or PPC (If HCG 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