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

CMS IOM 100-4 Medicare Claims Processing Manual, Chapter 1, Section 70.7.1 (PDF, 1.63 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, 235 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:

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