Timely Claim Submission
Medicaid providers should submit claims immediately after providing services so that any problems with a claim can be corrected and the claim resubmitted before the filing deadline.
A clean claim for services rendered must be received by the Medicaid office or its fiscal agent no later than 12 months from the date of service
In order for a claim to be paid, it must be a clean claim. A clean claim is a Medicaid claim that:
· Has been accurately and fully completed according to Medicaid billing guidelines.
· Is accompanied by all necessary documentation.
· Can be processed and adjudicated by the fiscal agent without obtaining additional information from the provider.
Date Received Determined
The date stamped on the claim by any Medicaid office or by the Medicaid fiscal agent is the recorded date of receipt for a paper claim. The fiscal agent date stamps the claim the date that it is received in the fiscal agent’s mailroom.
The date electronically coded on the provider’s electronic transmission by the Medicaid fiscal agent is the recorded date of receipt for an electronic claim.
Third Party Payer and Medicare Insurance Claims
Claims for recipients who have Medicare or other insurance must be submitted to a third party payer prior to sending the claim to Medicaid.
For non-Medicare claims, the claim must be received by Medicaid or the Medicaid fiscal agent no later than 12 months from the date of service or six months from the date of the other insurance payment or denial.
The filing limit for Medicare claims crossing over to Medicaid is the greater of 36 months from the date of discharge or 12 months from Medicare’s adjudication date.