After one year and prior to four years from the date of determination, "good cause" is required for Medicare to reopen the claim. An initial determination on a previously adjudicated claim may be reopened for any reason for one year from the date of that determination. If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within our timely filing period.If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB).However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. Medicare (Cigna Healthcare for Seniors): In accordance with Medicare processing rules, non-participating health care providers have 15 to 27 months to file a new claim.In Coordination of Benefits situations, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefits (EOB) or explanation of payment (EOP).Provider agreement specifically allows for additional time.Applicable law requires a longer filing period.There are some exceptions to these deadlines. Remember: Your contract with Cigna Healthcare SM prohibits balance billing your patient if claims are denied because they were not submitted within the time frame outlined above. If services are rendered on consecutive days, such as for a hospital confinement, the limit will be counted from the last date of service.Īs always, you can appeal denied claims if you feel an appeal is warranted.
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