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#Florida medicare timely filing guidelines 2018 full

LINA and NYLGICNY are not affiliates of Cigna.Īll insurance policies and group benefit plans contain exclusions and limitations. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT) (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA) or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. That insure or administer group HMO, dental HMO, and other products or services in your state). Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. If you are not currently registered for the Cigna for Health Care Providers website, go to and click on the Login/Register link.įind an in-network doctor, dentist, or facility If a resubmission is not a Cigna request, and is not being submitted as an appeal, the filing limit will apply.

If a claim was timely filed originally, but Cigna requested additional information.

In general, Medicare does not consider a situation where (a) Medicare processed a claim in accordance with the information on the claim form and consistent with the information in the Medicare's systems of records and (b) a third party mistakenly paid primary when it alleges that Medicare should have been primary to constitute "good cause" to reopen. After one year and prior to four years from the date of determination, "good cause" is required for Medicare to reopen the claim. An initial determination on a previously adjudicated claim may be reopened for any reason for one year from the date of that determination.

If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period.

If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB).

#Florida medicare timely filing guidelines 2018 full

However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. Medicare (Cigna for Seniors): In accordance with Medicare processing rules, non-participating health care providers have 15 to 27 months to file a new claim.

In Coordination of Benefits situations, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefits (EOB) or explanation of payment (EOP).

Provider agreement specifically allows for additional time.Applicable law requires a longer filing period.There are some exceptions to these deadlines. Remember: Your contract with Cigna prohibits balance billing your patient if claims are denied because they were not submitted within the time frame outlined above. If services are rendered on consecutive days, such as for a hospital confinement, the limit will be counted from the last date of service.Īs always, you can appeal denied claims if you feel an appeal is warranted.