Claims Timely Filing
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This policy governs when Wellpoint Washington Medicaid will consider reimbursement for initial claims based on timely receipt and acceptance. It applies to participating and nonparticipating providers and facilities, subject to applicable provider, state, federal, CMS, or contractual requirements.
The timely filing requirement was updated from 365 days to 12 months for participating and nonparticipating providers and facilities.
Timely Filing Reimbursement Criteria
Timely Filing Reimbursement Criteria
The health plan will consider reimbursement for an initial claim when all applicable criteria are met. Provider, state, federal, or CMS contracts and/or requirements may establish different requirements.
ALL of the following
- The claim is an initial claim.
- The claim was received and accepted within the applicable timely filing limit.
The applicable timely filing limit is determined as follows
- Apply the applicable federal or state mandate, when one exists.
- If no applicable federal or state mandate exists, apply the health plan standard of 12 months for participating providers and facilities and 12 months for nonparticipating providers and facilities.
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