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As a result, in such situations, providers must file the claim promptly after error was probably corrected. CMS indicates that Medicare contractors could determine good cause exists when an administrative error on an official part Medicare employee acting on Medicare behalf contractor within scope of his/her authority caused the delay. There have probably been no appeal rights on denied claim. Circumstances such as backdated Medicare entitlement may as well qualify for a timely extension filing deadline. Federal regulations 42 CFR 42 § 422.504(g) requires us to protect Aetna ® members from financial liability, therefore, appeals must include a signed Waiver of Liability (WOL) form.The following is important information regarding recent New York State Managed CareĮffective April 1, 2010, New York State Managed Care regulations stipulate that health careĬlaims must be submitted by health care providers within 120 days of the date of serviceĬenters for Medicare Medicaid maintenance requires Medicare contractors to deny claims submitted after timely file limit is expired. You may submit an appeal for a claim denied based on error or absence of fact, except for timely filing. This requires the provider to fill out the non-PAR Provider Appeal form. This requires the provider to request access to the portal.Ĭlaim Reconsiderations for non-PAR providers (Appeal) - a claim for a non-contracted provider in which the provider is not correcting the claim in anyway, but disagrees with the original claim outcome and wishes to challenge the payment or denial of a claim. This requires the provider to fill out the PAR Provider Dispute form.Īlternatively, a PAR provider can also submit a Reconsideration via the secure web portal for better convenience. Or you can mail hard copy claims or resubmissions to:Ĭlaim Reconsiderations for PAR providers (Dispute) – a claim for a PAR provider in which the provider is not correcting the claim in anyway, but disagrees with the original claim outcome and wishes to challenge the payment or denial of a claim.
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