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Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided unless an exception applies. If a claim isn't filed within this time, Medicare won't pay its share.
Timely Filing. As a result of the Patient Protection and Affordable Care Act (PPACA), all claims for services furnished on/after January 1, 2010, must be filed with your Medicare Administrative Contractor (MAC) no later than one calendar year (12 months) from the date of service (DOS) or Medicare will deny the claim.
Medicare Claims Processing Manual . Chapter 1 - General Billing Requirements . Table of Contents (Rev. 12789, Issued: 08-15-24) Transmittals for Chapter 1. 01 - Foreword 01.1 - Remittance Advice Coding Used in this Manual 02 - Formats for Submitting Claims to Medicare 02.1 - Electronic Submission Requirements 02.1.1 - HIPAA Standards for Claims
Timely Filing Requirements. The Medicare regulations at 42 C.F.R. §424.44 and the CMS Medicare Claims Processing Manual, CMS Pub. 100-04, Ch. 1, §70 specify the time limits for filing Part A and Part B fee-for- service claims.
Medicare claims must be filed to the MAC no later than 12 months, or 1 calendar year, from the date the services were furnished. This includes resubmitting corrected claims that were unprocessable. Use the Claims Timely Filing Calculator (JH) (JL) to determine the timely filing limit for your service.
The Centers for Medicare & Medicaid Services (CMS) fact sheet advise that the timely filing period for both paper and electronic Medicare claims is 12 months, or one calendar year, after the date of service. Claims are denied if they arrive after the deadline date.
Section 6404 of the Affordable Care Act amended sections 1814(a)(1), 1835(a)(1), and 1842(b)(3)(B) of the Act, by reducing the maximum time period for filing Medicare Part A and Part B claims to no more than 12 months after the date of service.