Can I attach a copy of my Remittance Advice (RA) as a timely extension? No. The fiscal agent does not accept attachments via batch submissions. Attachments should be submitted with the claim via the Provider Web Portal. Providers must enroll and submit claims within 365 days from the DOS.Ĭlaims that are not able to be submitted within the 365-day guideline, but have one (1) of the above documents attached to the submission will be put into suspended status and will be reviewed by the fiscal agent. A backdate approval letter (new enrollments, affiliations or updates are not acceptable reasons for late filing).Claims that have been date-stamped by the fiscal agent or the Department and returned to the provider.The following are examples of acceptable proof of timely filing: If any of the scenarios listed below apply, but the claim in question is still within the 365-day window, a waiver is not needed and the provider only needs to resubmit the claim. How can a provider qualify for a timely waiver (override)? The previous ICN must be referenced on the claim, even if the claim is over 365 days. Providers must also resubmit claims every 60 days after the initial timely filing period (365 days from the DOS) to keep the claim within the timely filing period. What should providers do if the initial 365-day window for timely filing is expiring? Providers are required to submit the initial claim within 365 days, even if the result is a denial. What date is used when considering timely filing deadlines? A claim is considered filed when the fiscal agent documents receipt of the claim. A timely filing waiver or a previous Internal Control Number (ICN) is required if a claim is submitted beyond the 365-day timely filing period. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.What is the deadline for meeting timely filing requirements? Providers always have at least 365 days from the DOS to submit a claim. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. If a claim for payment under Medicare has been filed in a timely manner, the Fiscal Agent must receive a SoonerCare claim relating to the same services within 90 days after the agency or the provider receives notice of the disposition of the Medicare claim.ĭisclaimer. The OHCA rules found on this Web site are unofficial. (c) To be eligible for payment under SoonerCare, claims for coinsurance and/or deductible must meet the Medicare timely filing requirements. (b) Claims may be submitted anytime during the month. A denied claim can be considered proof of timely filing.
Payment will not be made on claims when more than 6 months have elapsed between the date the service was provided and the date of receipt of the claim by the Fiscal Agent. For dates of service provided on or after July 1, 2015, the timely filing limit, for SoonerCare reimbursement, is 6 months from the date of service.
Federal regulations provide no exceptions to this requirement. (a) According to federal regulations, the Authority must require providers to submit all claims no later than 12 months from the date of service.
0 kommentar(er)
