Reviewing past medical and accounting records for eligibility and billing information for services provided.Some examples of appropriate action include: Providers are expected to take appropriate and reasonable action to identify Health First Colorado eligibility in a timely manner.
What if the member did not notify the provider of eligibility?
Aetna timely filing limit for secondary claims software#
If the issue is between the provider and the software vendor, billing agent or clearinghouse, this does not constitute an acceptable reason to be outside the timely filing period. What if the issue was with my vendor? Issues resulting in failure to transmit accurate and acceptable claims or failure to identify transmission errors in a timely manner must be addressed. The claim must be submitted, even if the result is a denial. Phone calls and other correspondence are not proof of timely filing.
What if I contacted the Department or fiscal agent and I am still waiting for a response? Waiting for prior authorization or correspondence from the Department or the fiscal agent is not an acceptable reason for late filing. If there is an RA within the last 60 days, providers must reference the previous ICN. Can I attach a copy of my Remittance Advice (RA) as a timely extension? No. The fiscal agent does not accept attachments via batch submissions. Attachments should be submitted with the claim via the Provider Web Portal. Providers must enroll and submit claims within 365 days from the DOS.Ĭlaims that are not able to be submitted within the 365-day guideline, but have one (1) of the above documents attached to the submission will be put into suspended status and will be reviewed by the fiscal agent.
If previous notes states, appeal is already sent.If we have clearing house acknowledgement date, we can try and reprocess the claim over a call.If claim history states the claim was submitted to wrong insurance or submitted to the correct insurance but not received, appeal the claim with screen shots of submission as proof of timely filing(POTF) and copy of clearing house acknowledgement report can also be used.If the first submission was after the filing limit, adjust the balance as per client instructions. Review the application to find out the date of first submission.Whenever claim denied as CO 29-The time limit for filing has expired, then follow the below steps: If claims submitted after the timely frame set by insurances, then those claims will be denied by insurance companies as CO 29-The time limit for filing has expired. Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims.
0 kommentar(er)
