(a) According to federal regulations, claims must be received by the Fiscal Agent within one year from the date of service.  Payment will not be made on claims when more than 12 months have elapsed between the date the service was provided and the date of receipt of the claim by the Fiscal Agent.  Federal regulations provide no exceptions to this requirement.  Because of this requirement, caution should be exercised to assure claims are filed timely in all cases where an application for assistance has been filed.  The following procedure is recommended.  If the service is approaching the one year time limit and a case number has not been assigned and an approval for medical assistance has not been received, or there is a case number but the medical assistance case has not been approved, or a provider contract has not been approved, file a claim.  The claim will be denied, however, the denial is proof of timely filing.

(b) Claims may be submitted anytime during the month.

(c) To be eligible for payment under Medicaid, claims for coinsurance and/or deductible must meet the Medicare timely filing requirements.  If a claim for payment under Medicare has been filed in a timely manner, the Fiscal Agent must receive a Medicaid claim relating to the same services within 90 days after the agency or the provider receives notice of the disposition of the Medicare claim.