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Aetna medicare timely filing limit for corrected claims manuals#

In these cases, you dont have to send us a Medicare primary COB claim. If the Medicare electronic remittance advice (ERA) or Explanation of Payment (EOP) contains an 'MA 18' or 'N89' remark code, the Medicare carrier has automatically sent us your claim. Providers can submit a variety of documents to GEHA via their web account. We can accept both Medicare Part A and Part B claims electronically from Medicare. The claim detail will include the date of service along with dollar amounts for charges and benefits.

Aetna medicare timely filing limit for corrected claims manuals#

Please be advised that validation of any and all HIPAA information will occur.įor additional information regarding rejected claims and timely filing requirements and contact information, you may refer to the Superior’s Provider Manuals located on Superior’s Provider Training and Manuals webpage. Click on an individual claim to view the online version of a GEHA explanation of benefits form (EOB). That sounds simple enough, but the tricky part isn’t submitting your claims within the designated time. 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.

1-87 for Ambetter from Superior HealthPlanįor claims related questions, be sure to have your claim number available, and contact your local Account Manager. Timely filing is when you file a claim within a payer-determined time limit.

1-87 for Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS) and CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP) and Allwell from Superior HealthPlan (HMO and HMO SNP).

Please note: All rejected claims must be corrected and resubmitted within 95 days of the date of service, and therefore a previously rejected claim will not be honored to substantiate timely claim filing.įor questions on claim payments, rejections, denials, to verify eligibility or for help escalating any issues, please contact Provider Services at:

Nursing facility claims within 365 days from the date of service on the claim.

Inpatient hospital claims (including all interim bills) within 95 days from the date of discharge.

Outpatient (office, facility, ancillary) provider claims within 95 days from each date of service on the claim.

Timely Claim Filing: The receipt of a clean claim must be within the timeframe applicable to the claim type.

These requests require one of the following attachments.

For an out-of-network health care professional, the benefit plan decides the timely filing limits. Claims can be rejected by the Superior’s clearinghouse, Electronic Data Interchange (EDI) process or claims process. Denied as Exceeds Timely Filing Timely filing is the time limit for filing claims, which is specified in the network contract, a state mandate or a benefit plan. Rejected Claim (Unclean Claim): An unclean claim that does not contain all elements necessary to process the claim, and/or is not the responsibility of Superior for adjudication. 1 A corrected claim must be submitted within the timely filing period for claims.

As a reminder, providers should review the definitions for rejected (unclean) claims and timely claim filing below: Aetna Corrected Claim Form aetna international claim form, aetna better health provider newsletter, aetna corrected claim.