It may be a variety of things such as a typo on the part of the biller, it may be that the patient offered the wrong insurance card at the medical office, or it may be that when the information was transferred from the person who took the info to the person who is doing the medical billing and coding it wasn’t copied correctly. The reason for a denial is when a claim is initially submitted with incorrect information. Other times, claims are denied for timely filing when they were not filed within the timely filing period due to initial mistakes. There are many reasons this can happen, but the important part of the equation is how the biller responds to the denial. It is important to follow these guidelines or your claims may be denied for timely filing.Ĭlaims are often denied for timely filing when the claim was actually submitted in a timely fashion but not received by the insurance carrier. Some are as short as 30 days and some can be as long as two years. Each insurance carrier has its own guidelines for filing claims in a timely fashion. The time limit is calculated from the date service provided. If you are not already registered, create a new account by registering at / or call 1-87.Insurance will deny the claim with denial code CO 29 – the time limit for filing has expired, whenever the claims submitted after the time frame. There are no changes, as PaySpan ® Health will continue to be the provider of Electronic Funds Transfer (EFT) and Electronic Remittance Advice/Explanation of Payment (ERA/EOP) free solutions. Payer GuidanceĬlaim Payment Disputes (related to untimely filing, incidental procedure, unlisted procedure code)Īttn: Adjustments/Reconsiderations/DisputesĬlaim Appeals (Medical) (Medical necessity, authorization denials, benefits exhausted and non-covered procedures)Ĭlaim Appeals (Medical) (Medical necessity, authorization denials, benefits exhausted and non-covered procedures)Įlectronic Funds Transfer and Electronic Remittance: Use the same date of service guidance on the first page to determine the correct payer. Your billing department will need to submit to the appropriate payer to prevent payment delays. The websites below provide information to help providers find answers. Sunshine Health Plan, Children’s Medical Services Health Plan - Operated by Sunshine value our partnership and are here to help. Staywell Health Plans, Children's Medical Services Health or after If you have any questions, please contact the EDI Department at the email address below. EDI: Institutional statement date is located in Loop 2300 (DTP*434*from-through~).EDI: Professional (837P) earliest service date in all claim lines is located in Loop 2400 (DTP*472*from-through~).If billing a professional or an outpatient bill type institutional submission, please use the earliest “from” date in the claim submission as outlined below. EDI: Professional (837P) service date for all claim lines is located in Loop 2400 (DTP*472*from-through~).1, 2021, please split the services into two separate claim submissions as outlined below. If billing a professional submission with services spanning before and after Oct. How to determine the correct payer by date of service: Sunshine Health, Children’s Medical Services Health Plan - Operated by Sunshine Health Please review the guidance below and update your system accordingly. Failure to follow these instructions may result in eligibility rejections. Box based on date of service guidance below. If you must submit paper claims, you must mail to the appropriate payer’s P.O. Electronic claim submission (EDI) is the preferred method for fast and accurate processing. We want your claim submissions processed as efficiently as possible. We value your partnership and want to help ensure proper claim submission to each plan based on the dates of service. 1, 2021. WellCare Medicare products, claims and correspondence procedures are not changing at this time. Sunshine Health will also operate the Department of Health’s Children's Medical Services Health Plan beginning Oct. 1, 2021Ĭentene’s acquisition of WellCare's Medicaid products, including Staywell Health Plan, will be complete Oct. Guidelines for proper claims submissions effective Oct.
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