How to decipher filing limits for Medicare claims

February 5, 2010

Field questions on Medicare claims limits

Key Points

A: Effective April 1, 2009, the retroactive filing limits for providers in the credentialing or recredentialing process were reduced from 27 months to 30 days from the date of the application filing. If a new provider submits an application dated April 1, then the only claims that will be considered for payment after credentialing or recredentialing is complete will be those with dates of services March 1 or later.

The time limit for appealing denied claims (unprocessable claims technically are not denied claims and, therefore, do not fall within these time limits) was reduced from 150 days to 120 days, whereas the amount in controversy, or AIC, limits for a judicial review increased from $1,180 to $1,220. The amount for an administrative law judge hearing remains the same at $120.