03/15/2023

MDHHS Provides Timely Filing Policy Tips for Providers

Claims are due within 12 months from the date of service (DOS). Each claim received by MDHHS receives a Transaction Control Number (TCN) that indicates the date the claim was entered into CHAMPS. The TCN is used when determining the active review of a claim. For claims using the institutional format and MHPs, it is the “To” or “Through” date indicated on the claim. For all other providers, it is the date the service was rendered or delivered. Claims over one year old will only be considered if the reason for filing the claim late is due to one of the policy exceptions and the exception is properly documented. Claim replacements billing for late or additional charges must be filed within 12 months from the date of service. Claim adjustments require comments/notes/remarks.

All claims for services rendered prior to 1/01/2017 and have been kept active according to prior timely filing policy will be allowed to be considered if kept active every 120 days from the latest rejection. In all cases, claims must be submitted no later than 12/31/2017.

It is the provider’s responsibility to maintain appropriate records to prove timely filing and to provide documentation when required. Providers filing for an exception should review the current MPM for the exception criteria. A claim comment/note/remark is required.

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