![]() 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. Electronically: Write the Submit Reason as an e-claim by selecting "Additional Information" in the e-Claim Note Type.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.On Paper: Enter information in the appropriate field – either box 10D or 19.The payer may require the Submit Reason to appear in other areas of the claim.Enter the Payer Doc Ctrl # (if the field is not grayed out).Contact the payer directly with any questions about correct claim submissions. Select the correct Submit Reason code. The Submit Reason code depends on the payer’s requirements.Click the arrows next to Miscellaneous to expand.Look for and double-click on the encounter that needs correcting. ![]() ![]() Click Encounters > Track Claim Status.For example, Medicare will not accept any Claim Submission Reason Code other than “1 –Original.” Do not change the Submit Reason unless you are certain the payer needs it changed. Note: The submit reason code depends on the payer's requirements. If the claim needs to be resubmitted as a corrected claim (per payer request), follow the instructions below to enter the submit reason on the encounter:.If the initial claim is still processing, this rejection will not affect the status of the initial submission.Determine if the claim needs to be corrected and (if so) how to properly resubmit. If the exact claim was submitted within 48 hours of the previous claim, contact the payer to verify the status of the previous claim submission.Resolution steps will vary depending on the cause: The submission reason code and additional information was not included on the corrected claim that was resubmitted.The exact claim was resubmitted within 48 hours of the last submission.This rejection message indicates that the payer has received the exact claim or service before. The actual rejection in their system is: DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE This rejection message and solution is specifically for claims billed to Humana. ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM THE CLAIM/ENCOUNTER HAS BEEN REJECTED AND H - HumanaĪCKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM THE CLAIM/ENCOUNTER HAS BEEN REJECTED AND H
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