Submitting an incorrect claim ID number after a claim has been adjusted. You must first void the original claim submission and resubmit a new claim using the correct form type i.e., provider submits an original claim on a CMS-1500, the provider must first void the original claim and resubmit a new claim on the correct claim form type using the CMS-1450. When the original claim form type submitted is the incorrect claim form type and needs to be corrected. Resubmit as an original claim or validate the corrected claim you submitted has the correct original claim ID number. When the original claim ID number submitted cannot be located in our claims processing system. When providers do not file corrected claims with the appropriate frequency or type of bill code, claims must be returned or manually researched which creates delays in providers receiving their reimbursement, and additional administrative tasks and resources are spent trying to resolve many corrected claims.Įffective 08-01-2023 Blue Cross NC will begin rejecting corrected claims submissions, and these claims will be mailed back regardless of whether the claim was filed electronically or on paper, for the following three scenarios: Claims are only eligible to be considered as corrected claims when they are resubmitted after being previously processed for payment.Įach month, Blue Cross NC receives a large volume of corrected claims that have not been filed appropriately. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) would like to remind providers that when filing corrected claims, coding guidelines require specific data elements. Send these materials to the following address.Īny inquiry about the status of your appeal request should be directed to or by calling (617) 847-3115. all the remittance advices the claim has appeared on (including the 853/855 denial), and. a cover letter to include a valid e-mail address. If you have a current approved electronic claim submission waiver, you can submit your appeal on paper. To file an appeal, you must submit the final deadline appeal request electronically via Direct Data Entry. In order for your appeal to be approved, you must demonstrate that the claim was denied or underpaid as a result of a MassHealth error, and could not otherwise be timely resubmitted. MEDICARE TIMELY FILING RESUBMISSION CODE
You must file the appeal within 30 days of the date that appears on the remittance advice on which your claim first denied with error code 853 or 855. To be eligible for appeal, your claim must have been denied for error code 853 or 855 (Final Deadline Exceeded). A claim with this error code cannot be appealed.Īppeal procedures for error codes 853 or 855 ('Final Deadline Exceeded') If the date of service is more than 36 months when it is received by MassHealth, the claim will be denied for error 856 or 857 (Date of Service Exceeds 36 Months) on an RA. See the following section for the appeal procedures for these error codes If you exceed this deadline, your claim will be denied for error code 853 or 855 (Final Deadline Exceeded) on an RA. You have 18 months from the service date to resolve your claim, as long as the claim was received by MassHealth within 90 days of the EOB date. If you exceed this deadline, your claim will be denied for error code 853 or 855 (Final Deadline Exceeded) on an RA. See the following section for the appeal procedures for these error codesįinal submission deadline if you had to bill another insurance carrier before billing MassHealth. You have 12 months from the date of service to resolve your claim, if you originally submitted the claim within 90 days from the date of service. If you had to bill another insurance carrier before billing MassHealth, you have 90 days from the date of the explanation of benefits (EOB) of the primary insurer to submit your claim.įinal submission deadline.
Initial claims must be received by MassHealth within 90 days of the service date. Usual turnaround time for Medicare/MassHealth crossover claims forwarded to MassHealth by the Massachusetts Medicare fiscal agent to be processed. Average time for both electronic (EDI) and paper claims to process on a remittance advice (RA).
0 kommentar(er)
