In order to be reimbursed for services rendered, all providers
must comply with the following filing limits set by Louisiana Medicaid:
-
Straight Medicaid claims must be filed within 12 months of the date of service.
-
KIDMED claims
must be filed within 60 days from the date of service.
-
Claims for
recipients who have Medicare and Medicaid coverage must be filed with the
Medicare fiscal intermediary within 12 months of the date of service in order to
meet Medicaid's timely filing regulations.
-
Claims which
fail to cross over via tape and have to be filed hard copy MUST be filed within
six months after the date on the Medicare Explanation of Medicare Benefits (EOMB),
provided that they were filed with Medicare within one year from the date of
service.
-
Claims with
third-party payment must be filed to Medicaid within 12 months of the date of
service.
Dates of Service Past Initial Filing Limit
Medicaid claims received after the initial timely filing limits
cannot be processed unless the provider is able to furnish proof of timely
filing. Such proof may include the following:
OR
To ensure accurate processing when resubmitting the claim
and documentation, providers must be certain that the claim is legible.
Proof of timely filing documentation must reference the individual recipient and
date of service.
At this time Louisiana Medicaid does not accept printouts
of Medicaid electronic remittance advice screens as proof of timely
filing. Documentation must reference the individual recipient and
date of service. Postal "certified" receipts and receipts from
other delivery carriers are not acceptable proof of timely filing.
Dates of Service Over Two Years Old
Claims with dates of service over two years old are not to be
submitted to Molina Medicaid Solutions or to the BHSF for overriding of the timely filing edit
unless one or more of the guidelines listed below is met:
-
The recipient was certified for retroactive Medicaid benefits.
-
The recipient
won a Medicare or Social Security Information appeal in which he was granted retroactive Medicaid
benefits, and/or;
-
The failure
of the claim to pay was the state's, rather than the provider's fault each time
the claim was adjudicated.
ATTENTION ALL PROVIDERS CLAIMS VOIDED DUE TO TIMELY FILING ERROR 4/14/15