This time limit applies to both initial and corrected claims. A claim will be considered for payment only if it is received by Aetna Better Health® of Illinois no later than 180 days from the date on which services or items are provided. Please be advised that validation of any and all HIPAA information will occur.įor additional information regarding rejected claims and timely filing requirements and contact information, you may refer to the Superior’s Provider Manuals located on Superior’s Provider Training and Manuals webpage. To ensure that professional claims billed on the CMS 1500 form are paid accurately and according to standard Medicare claims rules, starting on October 1, 2022. Other names, what is aetna timely filing limit for corrected claims. To be eligible for reimbursement, providers must file claims within a qualifying time limit. 1-87 for Ambetter from Superior HealthPlanįor claims related questions, be sure to have your claim number available, and contact your local Account Manager.1-87 for Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS) and CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP) and Allwell from Superior HealthPlan (HMO and HMO SNP) Were dedicated to helping your practice run as efficiently as possible, which is why we always strive for prompt claims processing.Please note: All rejected claims must be corrected and resubmitted within 95 days of the date of service, and therefore a previously rejected claim will not be honored to substantiate timely claim filing.įor questions on claim payments, rejections, denials, to verify eligibility or for help escalating any issues, please contact Provider Services at: Nursing facility claims within 365 days from the date of service on the claim.except on Medicare claims, which is 18 months from the date of the initial service. Inpatient hospital claims (including all interim bills) within 95 days from the date of discharge. Whether a claim is filed by you or by a service provider filing a claim.Outpatient (office, facility, ancillary) provider claims within 95 days from each date of service on the claim.Timely Claim Filing: The receipt of a clean claim must be within the timeframe applicable to the claim type.Claims can be rejected by the Superior’s clearinghouse, Electronic Data Interchange (EDI) process or claims process. Rejected Claim (Unclean Claim): An unclean claim that does not contain all elements necessary to process the claim, and/or is not the responsibility of Superior for adjudication.The initial claim, however, will be processed. As a reminder, providers should review the definitions for rejected (unclean) claims and timely claim filing below: Timely Filing Protocols Once an initial claim is accepted, any subsequent (repeat) filing, regardless if it is paper or electronic, will be denied as a duplicate filing.
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