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    OpenPayerPolicy UpdatesAdministrative/Operational PolicyMississippi Medicaid timely filing policy | OpenPa…
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    CurrentMississippi Division of MedicaidPolicy N/A

    Timely Filing of Medicaid Claims

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    Sets timely filing deadlines and related rules for providers submitting claims to the Mississippi Division of Medicaid, including special rules for newly enrolled providers, claims recouped from Coordinated Care Organizations (CCOs), and claims related to Medicare adjudication. Affects all providers billing Mississippi Medicaid.

    Policy Summary
    PayerMississippi Division of Medicaid
    PolicyTimely Filing of Medicaid Claims
    Policy CodePolicy N/A
    Change TypeNon‑material revision (12/01/2020)
    Effective DateJul 1, 2019
    Last ReviewDec 1, 2020
    Next Review Date
    Key ActionProviders must submit claims no later than 365 calendar days from date of service.
    SourceLink
    POLICY UPDATE CHANGES

    Rule language was revised with an effective date of 12/01/2020.

    365 daysstandard timely filing period
    365 daysnewly enrolled providers
    90 daysCCO recoupment deadline after 365 days
    180 daysMedicare-related processing window
    Policy Summary
    PayerMississippi Division of Medicaid
    PolicyTimely Filing of Medicaid Claims
    Policy CodePolicy N/A
    Change TypeNon‑material revision (12/01/2020)
    Effective DateJul 1, 2019
    Last ReviewDec 1, 2020
    Next Review Date
    Key ActionProviders must submit claims no later than 365 calendar days from date of service.
    SourceLink
    On This Page
    Timely Filing Coverage CriteriaCoding and TimeframesProvider Requirements and ActionsKey Definitions

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    0amount billable to beneficiary for late claim

    Timely Filing Coverage Criteria

    Timely Filing Criteria

    Covered when ALL of the following timely‑filing rules are met:

    ALL of the following

    • Standard claims must be submitted within 365 calendar days from the date of service.
    • Newly enrolled providers must submit claims within 365 calendar days from the date of service, and those claims must be for services provided on or after the provider's enrollment effective date.

    • ALL of the following

      • Either

        • Claims originally submitted to and paid by a Coordinated Care Organization (CCO) must be submitted to the Division of Medicaid within 365 calendar days from the date of service.
        • If the CCO recoupment occurs after the 365‑day timely filing period, the claim must be submitted within 90 calendar days of the CCO recoupment date.
    • If a Medicare claim for the same services was filed in a timely manner, the Division of Medicaid will process the related Medicaid claim within 180 calendar days after the agency or provider receives notice of the Medicare claim disposition.
    • If a provider fails to meet the timely filing requirements, the beneficiary cannot be billed for those services.

    Coding and Timeframes

    N/Amixed
    No codes listed
    Standard timely filing window
    Standard timely filing window365 calendar days from date of service
    Newly enrolled providersClaims must be submitted within 365 calendar days from date of service and only for services on/after the provider's enrollment effective date
    CCO-recouped claims deadlineSubmit within 365 days of service or within 90 days of the CCO recoupment if recoupment occurs after the 365-day period

    Provider Requirements and Actions

    Billing Rule

    Timely filing and related billing rules

    Providers must submit claims no later than 365 calendar days from the date of service. Newly enrolled providers must also submit claims within 365 calendar days from the date of service and only for services provided on or after the provider's enrollment effective date. Claims originally paid by a Coordinated Care Organization (CCO) but later recouped must be submitted to the Division of Medicaid either within 365 calendar days from the date of service or within 90 calendar days of the CCO recoupment if that recoupment occurs after the 365-day timely filing period. If a Medicare claim was filed in a timely manner, Medicaid will process a related Medicaid claim within 180 calendar days after the agency or provider receives notice of the Medicare claim disposition. Providers may not bill beneficiaries for services when the provider fails to meet the timely filing requirements.

    • Standard timely filing window: submit claims no later than 365 calendar days from date of service.
    • Newly enrolled providers: 365‑day rule applies and only for services on/after the provider's enrollment effective date.
    • CCO recoupment: submit within 365 days of service, or within 90 days of the CCO recoupment if that recoupment occurs after the 365‑day period.
    • Medicare-related claims: Medicaid will process related claims within 180 calendar days after notice of Medicare disposition.

    Key Definitions

    CCO (Coordinated Care Organization)
    DefinitionCoordinated Care Organization (CCO)
    Context in policyClaims originally submitted to and paid by a CCO but later recouped due to beneficiary enrollment changes must be resubmitted to the Division of Medicaid per timely filing rules
    Related deadlineCCO-recouped claims must follow 365-day standard or 90 days from recoupment if recoupment occurs after the 365-day period
    FFS (Fee-for-Service)
    DefinitionFee-for-Service (FFS)
    Context in policyRefers to the Medicaid delivery model to which a beneficiary may be transferred from a CCO, triggering recoupment and resubmission rules
  1. Billing prohibition: providers may not bill beneficiaries for claims that fail timely filing.
    2. Interaction with CCOsWhen beneficiary enrollment changes from a CCO to FFS and a CCO retrospectively recoups payment, providers must follow specified resubmission timeframes