June 28, 2018
On June 19, 2018, the Family and Social Services Administration’s (“FSSA”) Indiana Health Coverage Programs (“IHCP”) released provider bulletin BT201829 regarding revising the timely filing limit for Medicaid fee-for-service claims. Beginning January 1, 2019, Medicaid fee-for-service claims will be required to be filed within 180 calendar days from the date of service. For inpatient claims, the 180 day limit will be based on the IHCP member’s date of discharge. Currently, the timely filing limit for Medicaid fee-for-service claims is 365 days, which will continue for claims with dates of service or dates of discharge on or before December 31, 2018. Notably, FSSA originally announced the agency’s intent to decrease the timely filing limit to 90 days, similar to the timely filing limit for managed care claims, but FSSA agreed to 180 days after negotiations during the 2018 legislative session.
Crossover claims and overpayment adjustment requests will continue to be excluded from the timely filing limit. Accordingly, for crossover claims, Medicare or Medicare Replacement Plan primary claims containing paid services will not be subject to the 180 day timely filing limit, but if Medicare or a Medicare Replacement Plan denies a claim, the 180 day timely filing limit will apply to the Medicaid claim. Further, for overpayment adjustment requests, such requests must be returned regardless of the 180 day timely filing limit.
The reasons for extending the timely filing limit (beyond the 180 days) will also remain unchanged, as follows:
If a member’s eligibility is effective retroactively, the timely filing limit is extended to 180 days from the date eligibility was established. Documentation identifying retroactive eligibility must be included.
The circumstances under which the timely filing limit may be waived will remain unchanged as well, as follows:
1 See IHCP Bulletin BT201829, available at: http://provider.indianamedicaid.com/ihcp/Bulletins/BT201829.pdf