Backdated Medicaid Cards
If a member receives a backdated medical card and the provider wishes to accept it and bill Medicaid for services that occurred over a year ago, the claims must be billed within one year of the issuance of the card. Claims must be billed on paper with a copy of the medical card or letter of eligibility and mailed to Provider Relations address at PO Box 2002, Charleston, WV 25327-2002.
Example: Services rendered by a physician on 3/1/2012; on 6/1/2012, member‟s Medicaid eligibility is granted effective 3/1/2012. All services previously rendered after 3/1/2012 can be billed to Medicaid, and considered for reimbursement if claims are received by 6/1/2013.
MCO‟s and Timely Filing
Molina does not reimburse for any services the provider does not bill timely to the MCO. If the MCO denial is due to the member not being covered under the MCO and the provider determines that the member was covered with WV Medicaid at the time services were rendered, Molina may be responsible. In this case, Molina will accept MCO Medicaid remits as proof of timely filing as long as the date of the denial is not over a year from the date of service. Please Note: The MCO must be one of the MCO‟s that are contracted with WV Medicaid and not an MCO that has a private insurance policy for the member.
To meet timely filing requirements for WV Medicaid, claims must be received within one year from the date of service. The year is counted from the date of receipt to the “from date” on a CMS 1500, Dental or UB04. Claims that are over one year old must have been billed and received within the one year filing limit. (See exceptions below for Medicare primary claims and backdated medical card.)
The original claim must have had the following valid information:
• Valid provider number
• Valid member number
• Valid date of service
• Valid type of bill
Claims that are over one year old must be submitted with a copy of the remittance advice showing where the claim was received prior to turning a year old. Claims with dates of service over two years old are NOT eligible for reimbursement.
This policy is applicable to reversal/replacement claims. If a reversal/replacement claim is submitted with a date of service that is over one year old, the replacement claim must be billed on paper with a copy of the original remittance advice to: Provider Relations, PO Box 2002, Charleston, WV 25327-2002. You are NOT allowed to add additional services to the replacement claim. If additional services are billed on the replacement claim that were not billed on the original claim and the dates of service are over one year old, the claim will be denied for timely filing.
Medicare Primary Claims/Secondary Claims
Timely filing requirement for Medicare primary claims is one year from the EOMB date. Did you know that secondary claims can be submitted electronically? For more information, please call our EDI help desk at 888-483-0793, option 6.