![]() Approval letters include information on steps the member should follow to activate supplemental member benefits. Upon receipt of all required information, the member will be sent an approval or denial letter within 10 business days.Submit a claim with the appropriate diagnosis codes from this office visit indicating a member has been diagnosed with one or more qualifying chronic conditions listed on.Submit an attestation form through indicating your patient meets the eligibility requirements.Follow the steps on to evaluate your patient against the eligibility requirements outlined on.Once appointment is made follow the steps below: Members are required to schedule an office visit with their doctor or participating physician group for evaluation. Steps to determine eligibility, submit attestations and activate benefits The loss of reimbursement for claims due to timely filing errors can be significant, and while some payers may allow an appeal, some are becoming very strict about the rules for overturning a timely filing denial.Special Supplemental Benefits for Chronically Ill (SSBCI) are offered to Wellcare’s highest-risk members who meet specific criteria for eligibility based on the Centers for Medicare and Medicaid Services (CMS) guidelines.Įffective January 1, 2023, you can check eligibility requirements and submit attestations on behalf of members online at In short, be sure to review all MA plan contracts or speak with an MA plan representative to be certain of the timely filing dates and educate all staff who may be involved with patient documentation and claims. Providers should check with the individual MA Plan to determine their timely claim filing requirements. "Question: Do Medicare replacement plans (Medicare Advantage (MA) Plans) generally follow Medicare guidelines for timely filing?Īnswer: We do not know about the timely filing guidelines for MA Plans. Upon review of a CGS Medicare FAQ on timely filing for Medicare Advantage plans, the following question and answer was received, They state this change is done in an effort to, " simplify our processes, align with industry standards, and better support coordination of care." Some providers and/or coding and billing staff may be unaware that, although the original or traditional Medicare Fee For Service plan has a one-year timely filing rule, patients who transfer their Medicare benefits over and join a Medicare Advantage Plan are required to follow the timely filing rules for their particular MA plan and most often, that filing requirement is significantly shorter than one year.Īs an example, on June 21, 2019, Anthem Blue Cross sent a notification to their network and contracted providers informing them that their new timely filing rule will become effective as of October 1, 2019, and the time for submitting a claim will be limited to 90 days from the date of service. ![]() They don't have (or cannot locate) their MA plan card but instead provide their original Medicare FFS card.They think they switched to a Medicare Advantage Plan but cannot remember.Whether they have the right insurance card.Which payer is primary and which is secondary.The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement a clean claim for services rendered must be received within one year of the date of service or risk payment denial.Īs any company who has billed Medicare services can attest, the one-year timely filing rule allows time to reconcile the many peculiar situations that arise when dealing with some Medicare beneficiaries who are unsure of the details of their coverage such as: News - industry news & Find-A-Code updatesīy Aimee L.Marketplace - recommended products & services.Library - buy digital books from Find-A-Code.Bookstore - buy physical books & cheat sheets.Subjects - Audits, E&M, HIPAA, Practice Mgt, etc.Specialties - Cardiology, ENT, Family Practice, etc.Payers - Medicare, Medicaid, BC/BS, Aetna, etc.Facilities & Organizations - ACOs, Hospitals, etc.
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