CurrentMississippi Division of MedicaidPolicy N/A

Rule 1.6: Timely Filing for Recouped Claims

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Establishes timely filing requirements for providers to submit claims to the Division of Medicaid for claims recouped by Coordinated Care Organizations (CCOs), including 365-day and 90-day deadlines when beneficiaries move from CCO enrollment to fee-for-service; affects providers submitting such recouped claims to Mississippi Medicaid.

Policy Summary

PayerMississippi Division of Medicaid

PolicyRule 1.6: Timely Filing for Recouped Claims

Policy CodePolicy N/A

Change TypeAdministrative filing (no text changes)

Effective DateDec 1, 2020

Next Review DateN/A

Key ActionProviders must submit recouped claims to the Division of Medicaid within 365 days of service or within 90 days of CCO recoupment when beneficiary moves to fee-for-service.

SourceLink

POLICY UPDATE CHANGES

Rule 1.6 (Timely Filing) is being filed to require providers to submit claims to the Division of Medicaid for any claims recouped from providers by the CCOs within 365 days of the date of service or within 90 calendar days of the recoupment from the CCO when the beneficiary moves from enrollment in a CCO to fee-for-service.

365 daystimely filing window from date of service

90 daystimely filing after CCO recoupment

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CurrentMississippi Division of MedicaidPolicy N/A

Rule 1.6: Timely Filing for Recouped Claims

Customize your policy alerts

Sign up for all Mississippi Division of Medicaid policy alerts

Know when Mississippi Division of Medicaid releases new policies or updates existing guidance.

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Policy Summary

PayerMississippi Division of Medicaid

PolicyRule 1.6: Timely Filing for Recouped Claims

Policy CodePolicy N/A

Change TypeAdministrative filing (no text changes)

Effective DateDec 1, 2020

Next Review DateN/A

Key ActionProviders must submit recouped claims to the Division of Medicaid within 365 days of service or within 90 days of CCO recoupment when beneficiary moves to fee-for-service.

SourceLink

POLICY UPDATE CHANGES

365 daystimely filing window from date of service

90 daystimely filing after CCO recoupment

Timely Filing Coverage Criteria

Timely filing criteria for recouped claims

Filing deadlines for claims recouped by Coordinated Care Organizations (CCOs):

Providers must submit claims to the Division of Medicaid for any claims recouped from providers by the CCOs within 365 days of the date of service.

If the beneficiary moves from enrollment in a CCO to fee-for-service, providers must submit the recouped claim to the Division of Medicaid within 90 calendar days of the recoupment from the CCO.

Coding and Thresholds

No specific billing or code references providedmixed

No codes listed

Timely filing thresholds

Timely filing window from date of service365 days from date of service for claims recouped by CCOs

Timely filing window after CCO recoupment when beneficiary moves to fee-for-service90 calendar days from the date of recoupment when beneficiary transitions from a CCO to fee-for-service

Governing ruleRule 1.6 (Title 23: Medicaid, Part 200, Chapter 1)

Effective date (as filed)Adoption filed to be effective Dec 1, 2020 (30 days after filing)

Required Provider Actions

Documentation Required

Timely filing for claims recouped by CCOs

Providers must submit claims to the Division of Medicaid for any claims recouped from providers by the CCOs within 365 days of the date of service; if the beneficiary moves from enrollment in a CCO to fee-for-service, providers must submit within 90 calendar days of the recoupment from the CCO.

Timely filing window from date of service: 365 days.
If beneficiary transitions from a CCO to fee-for-service, filing window from date of CCO recoupment: 90 calendar days.

Key Definitions

CCO (Coordinated Care Organization)

DefinitionCCO = Coordinated Care Organization, the entity referenced as recouping claims from providers

Role in this filingCCOs may recoup claims from providers; those recouped claims must be submitted to the Division of Medicaid within the specified timely-filing windows

Related action for providersWhen a CCO recoups a claim, providers must follow the timely-filing deadlines specified in Rule 1.6 to submit to the Division of Medicaid

Timely filing requirement for recouped claims

Primary requirementProviders must submit claims recouped by CCOs to the Division of Medicaid within 365 days of the date of service

Conversion scenarioIf beneficiary moves from enrollment in a CCO to fee-for-service, providers must submit recouped claims within 90 calendar days of the recoupment from the CCO