02/10/2022

Timely Filing for Medicaid

In new york state when a patient has medicare and medicaid. what is the amount of time you can send to medicaid without timely filing? Thank you

In New York State, providers are expected to file a claim with FFS Medicare within 90 days from the DOS or the date of the primary insurance payment. In some cases, there may be circumstances where you are not able to submit a claim within 90 days from the DOS (such as a patient becoming retroactively eligible with Medicaid). When there are circumstances that prevent you from submitting a claim within the specified timeframe, you have up to two years from the DOS to file a claim for reimbursement. However, the claim must have a “delay reason code” that indicates to Medicaid why a claim was submitted late for processing but still within timely filing. Note that these rules only apply to FFS Medicaid and if the patient is enrolled in a Medicaid Managed Care plan, all plans have different filing limits and will not accept claims for payment after their respective filing limit has passed.