The following is important information regarding recent New York State Managed Care regulations.Įffective April 1, 2010, New York State Managed Care regulations stipulate that health care claims must be submitted by health care providers within 120 days of the date of service. All member and provider information must be complete and accurate.All claims must be completed in accordance with accepted billing guidelines.

Options are available to file claims electronically through a clearinghouse, the Magnolia secure portal, or via paper submission.All claims for Magnolia Health for the MississippiCAN and Mississippi CHIP products must be filed within 180 days from the date of service (DOS).1, 2015, claims must be filed within six months from the date of service. MississippiCAN: Effective July 1, 2014, claims must be filed within six months from the date of service.Paper crossovers must be filed within 180 days of the Medicaid retroactive eligibility determination date. **Crossover claims over 180 days old can be processed if the beneficiary’s Medicaid eligibility is retroactive. NOTE: Claims filed after the 180 day limit will be denied. This is also applicable to Medicare Part C claims.

**Medicare crossover claims for co-insurance and/or deductible must be filed with the Division of Medicaid within 180 days of the Medicare paid date. **The 12 month filing limit for newly enrolled provider begins with the date of issuance of the provider’s Welcome Letter. **Claims over 12 months can be processed if the beneficiary’s Medicaid has been retroactively approved by DOM or Social Security Administration. Reconsidered claims within 90 days of timely filing adjudication.Ĭlaims for covered service must be filed within 12 months from the through/ending dates of service.Ĭlaims filed within the first 12 months and denied can be resubmitted with the original transaction control number (TCN). Timely filing within 180 days of date of service. If you have any questions, you are welcome to contact me directly at (123) 456-7890. If this claim is further denied, we intend to then file a complaint with the Office of the Insurance Commissionaire. We respectfully request that these claims be promptly processed and that are office is paid for the services rendered to your subscriber as allowed by the State prompt payment regulations. (or) I have attached a copy of our Claims Submittal Report provided by our electronic claims clearinghouse showing that the original submission date was well within your deadline. The printed date is the date of submission and is well within your deadline. Our office policy is to send all claims on the date they are produced. I have attached copies of the original claims showing the date they were printed. Please see the attached EOB from your company. On (date of denial) we received a denial of the claims for “timely filing”. On (date of resubmission) we resubmitted the claims for consideration. The promptly and properly submitted claims were neither paid nor denied by your company. This was well within your timely filing deadline. On (original submission date) we submitted claims for services rendered to the above patient. We are appealing the denial of claims for (patient name) and request that these claims be reviewed and paid. (etc – get this information from the denial)

Address (get address for appeals if it exists)

Bcbs timely filing appeal