Question: Our patient gave us her Medicare card but said Medicare was her secondary payer. She took a long time to get us her primary insurance card, and when we finally submitted the claim, the insurer was slow to get back to us. They eventually denied the claim. But when we tried to submit it to Medicare as secondary, the MAC said we exceeded the limit on timely filing requirements and rejected the claim. Can we file an exception report for this?
Oregon Subscriber
Answer: Unfortunately, it doesn’t sound like your situation warrants an exception to the timely filing requirements, which demand that you submit your claims within a year of the date of service. The exceptions are as follows:
In your case, it sounds more like the patient was too slow to give you her insurance card and then the primary insurer must have taken a while to process the claim.
Resource: You can read about the timely filing exceptions in the Medicare Claims Processing Manual at www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c01.pdf.