Provider Notice issued 07/23/12

​180 Day Time Limits for Claim Submittal

As a result of Public Act 097-0689(pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, effective with claims received on or after July 1, 2012, the department will be implementing a policy change relating to timely filing of claims.

To be eligible for Medicaid reimbursement, providers and suppliers must file claims within a qualifying time limit. A claim will be considered for payment only if it is received by the department no later than 180 days from the date on which services or items are provided. This time limit applies to both initial and resubmitted claims. Rebilled claims, as well as initial claims, received more than 180 days from the date of service will not be paid.

Exceptions:

• Medicare/Medicaid crossover claims must be submitted no later than 24 months after the date on which medical goods or services were provided.

• Providers whose enrollment is in process by the department, the 180 day period shall not begin until the “As-Of Date” on the HFS Provider Information Sheet. This date identifies when the provider enrollment was completed.

• Claims for services rendered during a period for which a recipient received retroactive eligibility, claims must be filed within 180 days after the department determined the applicant is eligible.

• Errors attributable to the department or any of its claims processing intermediaries which result in an inability to receive, process, or adjudicate a claim, the 180-day period shall not begin until the provider has been notified of the error.

• Claims for which the Illinois Medicaid is not primary payer, claims must be submitted to the department within 180 days after the final adjudication by the primary payer.

• Long Term Care admission documents shall be submitted within 30 days of an admission to the facility through the Medical Electronic Data Interchange (MEDI) or the Recipient Eligibility Verification (REV) System or shall be submitted directly the Department of Human Services using required admission forms.

• Confirmation numbers assigned to an accepted transaction shall be retained by a facility to verify timely submittal.

• Once an admission transaction has been completed, all resubmitted claims following prior rejection are subject to receipt no later than 180 days after the admission transaction has been completed.

• For hospital inpatient claims, the 180 days begins from the date of discharge.

Providers will have 180 days from the date on the HFS 2432 (Split Billing Transmittal/Spenddown Form) to submit a claim.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs