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Elizabeth M. Whitehorn, Director

Provider Notice issued 03/31/08

Timely Filing of Medicare/Medicaid Crossover Claims

To:​ ​All Enrolled Providers
​Date: ​March 31, 2008
​Re: Timely Filing of Medicare/Medicaid Crossover Claims​

The purpose of this notice is to inform providers of the department’s policy for timely filing of Medicare/Medicaid crossover claims.  The department must receive a claim after disposition by Medicare, or its fiscal intermediary, no later than twenty-four (24) months from the date on which the medical goods or services were provided.  Medicare/Medicaid crossover claims processed by the department, on or after, May 1, 2008, which do not meet this time frame, will be rejected with a new error code, D45, with the message “Submitted Later Than 2 Years After Service.”  This policy is codified in the department’s rules at 89 Illinois Administrative Code section 140.20(c) located on the department’s Web site at:

http://www.illinois.gov/hfs/info/legal/Pages/default.aspx

The new timely filing requirement will apply to the following claim types:

  • Electronic transmission received directly from Medicare;

  • HFS 3797, Medicare Crossover Invoice, paper or Direct Data Entry (DDE) via http://www.myhfs.illinois.gov/

  • Professional or Institutional claims denied by Medicare and submitted on the appropriate HFS claim form with the explanation of benefits attached; and

  • Institutional claims denied by Medicare due to Part A benefits exhausted with the explanation of benefits attached.

Professional claims denied by Medicare with the explanation of benefits attached must be submitted on the appropriate HFS paper claim form for special handling to the following address:

Bureau of Comprehensive Health Services

P.O. Box 19115

Springfield, Illinois  62794-9115

Institutional claims denied by Medicare with the explanation of benefits attached must be submitted on the paper form for special handling to the following address:

Bureau of Comprehensive Health Services

P.O. Box 19128

Springfield, Illinois  62794-9128

Your participation in our programs is greatly appreciated.  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