Timely filing for aetna12/22/2023 ![]() And like I always say, “With the right reminders, you can do almost anything-like squeeze into a suit with built-in abs.” Right? All super suits aside, here’s a payer deadline cheat sheet for participating providers, as adapted from multiple sources: Payerġ80 days from date of service (physicians)ĩ0 days from date of service (ancillary providers) But, you can use the chart below to remind you about your timely filing deadlines. So, how do you become a timely filing superhero? Well, unfortunately, there’s no sweet signal in the sky to warn you about timely claim submission danger. Furthermore, if you aren’t familiar with all of your timely filing deadlines and you end up submitting a claim late, you’ll be dealing with denials-the kind that typically can’t be appealed (Pow! Blap! Ouch!). So, while you and your staff are treating patients, determining diagnosis codes, and submitting claims, you also have to keep track of all your contracted requirements. That sounds simple enough, but the tricky part isn’t submitting your claims within the designated time frame it’s knowing what that time frame is, and that’s because there’s no set standard among all payers. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. Timely filing is when you file a claim within a payer-determined time limit. Whoops! I mean, check out these timely filing tips and download the cheat sheet below for reference. So, how do you know when your claim submissions are early, on time, or downright late? Look to the Bat-Signal for guidance, of course. ![]() Because with claim submissions, lateness isn’t only unacceptable it also causes denials. Or, maybe it’s because this rule truly applies in many situations-even in physical therapy billing. If you’re on time, you’re late.” Maybe I think that way because I have a Type A personality (holy organization, Batman). Non-network providers rendering prior authorized services follow the same timely filing guidelines as original Medicaid guidelines.įor assistance, please call Provider Relations at 1-85.When it comes to punctuality, here’s my motto: “If you’re early, you’re on time. Providers can resubmit hard copy claims directly to Aetna Better Health via mail to the following address:įailure to submit claims within the prescribed time period may result in payment delay and/or denial. Any claims with a frequency code of 5 will not be paid. Providers must additionally stamp or write one of the following labels on the claim if resubmitting a paper claim Resubmission Rebill Corrected bill Corrected Rebillingįor electronic resubmissions, providers must submit a frequency code of 7 or 8. Providers must include the nature of the request, member’s name, date of birth, member identification number, service/admission date, location of treatment, service or procedure, documentation supporting request, copy of claim, and a copy of remittance advice on which the claim was denied or incorrectly paid. Aetna Better Health will consider a claim for resubmission only if it is re-billed in its entirety.Ĭlaim Resubmission- MLTC Providers have 180 days from the date of remittance to resubmit a claim. New Claim -MLTC claims must be submitted within 120 days from the date of service. Our timely filing limitations are as follows: In accordance with contractual obligations, claims for services provided to an enrollee must be received in a timely manner. Reminder- Timely Filing of Claim Submissions These provider types are not use the UB-92 or CMS-1500 forms. This will be the claim form that will be used for these provider types. If a participating provider does not submit appropriately, claims may be delayed or denied.Ī reference guide to billing has been created to assist Home Care and Social day providers that will be impacted by the change on how to bill on UB-04. Home Care and Social Day Care providers in the Aetna Better Health of New York network will be required to submit all claims on UB 04. Billing Home Care and Social Day Care providers
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