** SECONDARY FILING – must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier’s EOB. ** INITIAL CLAIM – must be received at Cigna-HealthSpring within 120 days from the date of service. To ensure your claims are processed in a timely manner, please adhere to the following policies: Do not send your request to WPS Medicare using the Redetermination Form. WPS Medicare Redeterminations unit cannot grant any waiver to timely filing deadline after the claim probably was processed, since claims denied for timely filing do not have appeal rights. In rare cases, CMS permits Medicare contractors to extend time limit for filing a claim beyond the usual deadline if provider may show good cause for delay in filing the claim. As a result, in such situations, providers must file the claim promptly after error was probably corrected. CMS indicates that Medicare contractors could determine good cause exists when an administrative error on an official part Medicare employee acting on Medicare behalf contractor within scope of his/her authority caused the delay. There have probably been no appeal rights on denied claim.
Circumstances such as backdated Medicare entitlement may as well qualify for a timely extension filing deadline. The following is important information regarding recent New York State Managed CareĮffective April 1, 2010, New York State Managed Care regulations stipulate that health careĬlaims must be submitted by health care providers within 120 days of the date of serviceĬenters for Medicare Medicaid maintenance requires Medicare contractors to deny claims submitted after timely file limit is expired.
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