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Elizabeth M. Whitehorn, Director

Provider Notice Issued 03/19/2021

 

Date:   March 19, 2021

 

To:       All Medical Assistance Program Providers

 

Re:      Resumption of Timely Filing Editing May 1,2021

 

 

 

 

This notice informs providers that theDepartment will resume editing for timely filing beginning with claims receivedMay 1, 2021. This information appliesonly to claims for participants covered under traditional Medicaidfee-for-service, as well as claim information uploaded through the HFS COVID uninsured testingportal in accordance with the February 2, 2021 providernotice.

 

As a result of the current COVID-19 publichealth emergency (PHE), the Department had requested a waiver in early 2020 throughthe federal Centers for Medicare & Medicaid Services (CMS) to temporarilysuspend the one-year timely filing requirement. This waiver request wasultimately denied by CMS. With federal regulations for timely filing being oneyear from date of service, the Department was only able to suspend the G55 editrequired by State law (Public Act 97-0689), which rejects claims greater than 180 daysbut less than 365 days from date of service.

 

180-Day Timely Filing

The March 20, 2020 provider notice stated that the Department planned to extendthe 180-day timely filing limit to two months from the end date of the publichealth emergency. As the PHE declaration continued through 2020 and remains inplace, the Department is amending that earlier plan. The Department will resume180-day timely filing editing effective with claims received beginning May 1,2021.

 

One-Year Timely Filing

As there was a delay in implementing the HFS COVID uninsured testing portal, the Department will temporarily liftthe one-year timely filing deadline to allow providers sufficient time tosubmit claims that had been held. Providers should prioritize the most agedclaims for submittal. The Department will resume one-year timely filing editingeffective with claims received beginning May 1, 2021.

 

Long term care questions regarding thisnotice may be directed to the Bureau of Long Term Care at844-528-8444. All other questions may be directed to the Bureau ofProfessional and Ancillary Services at 877-782-5565.

 

 

 

Kelly Cunningham,Administrator

Division of MedicalPrograms​