What conditions will contractors allow for exceptions to and extension of timely filing requirements?

Answer:
The
CMS IOM 100-4 Medicare Claims Processing Manual, Chapter 1, Section 70.7.1 (PDF, 4.23 MB), contains what conditions contractors will allow for exceptions to and extensions of timely filing requirements.

The exceptions include:

  • Administrative error
  • Retroactive Medicare entitlement
  • Retroactive Medicare entitlement involving State Medicaid Agencies
  • Retroactive disenrollment from a Medicare Advantage (MA) plan or Program of All-inclusive Care of the Elderly (PACE) provider organization.
The CMS MSP Manual (Pub. 100-05), Chapter 3, Section 10.5 (PDF, 252 KB) also addresses this situation:

"In general, Medicare does not consider a situation where (a) Medicare processed a claim in accordance with the information on the claim form and consistent with the information in the Medicare's systems of records and; (b) a third party mistakenly paid primary when it alleges that Medicare should have been primary to constitute "good cause" to reopen." You may refer to:

Contact Palmetto GBA JM Part A Medicare


Provider Contact Center: 855-696-0705

Email Part A

Contact a specific JM Part A department

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 



spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer