Date: March 19, 2021
To: All Medical Assistance Program Providers
Re: Resumption of Timely Filing Editing May 1,
2021
This notice informs providers that the
Department will resume editing for timely filing beginning with claims received
May 1, 2021. This information applies
only to claims for participants covered under traditional Medicaid
fee-for-service, as well as claim information uploaded through the HFS COVID uninsured testing
portal in accordance with the February 2, 2021 provider
notice.
As a result of the current COVID-19 public
health emergency (PHE), the Department had requested a waiver in early 2020 through
the federal Centers for Medicare & Medicaid Services (CMS) to temporarily
suspend the one-year timely filing requirement. This waiver request was
ultimately denied by CMS. With federal regulations for timely filing being one
year from date of service, the Department was only able to suspend the G55 edit
required by State law (Public Act 97-0689), which rejects claims greater than 180 days
but less than 365 days from date of service.
180-Day Timely Filing
The March 20, 2020 provider notice stated that the Department planned to extend
the 180-day timely filing limit to two months from the end date of the public
health emergency. As the PHE declaration continued through 2020 and remains in
place, the Department is amending that earlier plan. The Department will resume
180-day timely filing editing effective with claims received beginning May 1,
2021.
One-Year Timely Filing
As there was a delay in implementing the HFS COVID uninsured testing portal, the Department will temporarily lift
the one-year timely filing deadline to allow providers sufficient time to
submit claims that had been held. Providers should prioritize the most aged
claims for submittal. The Department will resume one-year timely filing editing
effective with claims received beginning May 1, 2021.
Long term care questions regarding this
notice may be directed to the Bureau of Long Term Care at
844-528-8444. All other questions may be directed to the Bureau of
Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham,
Administrator
Division of Medical
Programs​
