Wiki TIMELY FILING DENIAL

[kcowan]

WHAT IS THE TIMELY FILING FOR A CLAIM FOR DRISCOLL MEDICAID, IF THEY HAVE A PRIVATE INSURANCE AS PRIMARY?

MY PROBLEM: WE HAD A PATIENT THAT HAD A PRIVATE INSURANCE PRIMARY, WE SUBMITTED OUR CLAIM TO THE PRIVATE INSURANCE FOR DATE OF SERVICE 01.11.23, THE PRIVATE INSURANCE WHICH WAS ENTRUST PAID THE CLAIM IN APRIL, WE FILED TO DRISCOLL IN MAY BUT DRISCOLL DENIED FOR TIMELY FILING?

 

[sls314]

WHAT IS THE TIMELY FILING FOR A CLAIM FOR DRISCOLL MEDICAID, IF THEY HAVE A PRIVATE INSURANCE AS PRIMARY?

MY PROBLEM: WE HAD A PATIENT THAT HAD A PRIVATE INSURANCE PRIMARY, WE SUBMITTED OUR CLAIM TO THE PRIVATE INSURANCE FOR DATE OF SERVICE 01.11.23, THE PRIVATE INSURANCE WHICH WAS ENTRUST PAID THE CLAIM IN APRIL, WE FILED TO DRISCOLL IN MAY BUT DRISCOLL DENIED FOR TIMELY FILING?

I'd make sure that the Medicaid plan shows themselves as secondary and that the primary payment information was included on the claim.

If the Medicaid plan doesn't show private insurance primary, its system may be trying to process it like a primary claim.

 

[trarut]

Excellent advice from Susan re: COB verification.

The provider manual I found online for Driscoll Health Plan shows a 95 day timely filing limit and would assume that is for all claims based on the wording. (For reference, Ohio Medicaid's timely filing is based on the primary payer process date, not the date of service, when they are the secondary payer.) I suggest checking out the provider manual as there is other valuable information in there about claim submissions. https://driscollhealthplan.com/wp/w...er-Manual-Sept_Final-New.pdf?ts=1688582083767