That sounds simple enough, but the tricky part isn’t submitting your claims within the designated time. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. Include copies of any supporting documentation, such as remittance advice(s), medical records or claimsįailure to specifically state the factual and legal basis may result in denial of the claim dispute. Timely filing is when you file a claim within a payer-determined time limit. Specifically state the factual and legal basis for the relief requested Was this content helpful Free Consultation. We can receive and respond to your dispute by fax, allowing you to get faster decisions: 60.īe sure to include all supporting documentation with the initial claim dispute submission. This video features an overview of how to submit a secondary claim to Aetna on Availity. This is because you are a contracted provider with Mercy Care Advantage. You must submit claims you’re disputing through the resubmission process.įederal regulations prohibit us from handling your complaints under the Medicare Advantage appeals process. (b) Full, fair, accurate, timely and understandable disclosure in the periodic. 18 months from the claim denial or payment date, upon written requests (or 30 months if COB issues). On February 28, 2021, Aetna International Inc. These time frames are according to the Arizona Revised Statute, Arizona Administrative Code and AHCCCS guidelines.Ĭontracted providers with Mercy Care Advantage do not have claim dispute rights. Time allowed to file an initial claim-payment dispute. Within 60 days after the date of the denial of a timely claim submission, whichever is later Within 60 calendar days of receiving the request. Within 12 months after the date that eligibility is posted Within 180 calendar days of an initial claim decision or utilization review decision. Within 12 months after the date of service All disputes related to a claim for system-covered services must be filed in writing and received by the administration or the prepaid capitated provider or program contractor within one of these time frames: Appeals/Corrected Claims 180 days from date of denial or payment.
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