It is not effective to rely solely on billing statements, collection notices, or collection agencies as the only means of obtaining eligibility and billing information. Verifying eligibility through the Provider Web Portal.Contacting the member by phone or by mail.Requesting billing information from the referring provider or facility where the member was seen.Reviewing past medical and accounting records for eligibility and billing information for services provided.Some examples of appropriate action include: Providers are expected to take appropriate and reasonable action to identify Health First Colorado eligibility in a timely manner. What if the member did not notify the provider of eligibility? If the issue is between the provider and the software vendor, billing agent or clearinghouse, this does not constitute an acceptable reason to be outside the timely filing period. What if the issue was with my vendor? Issues resulting in failure to transmit accurate and acceptable claims or failure to identify transmission errors in a timely manner must be addressed. The claim must be submitted, even if the result is a denial. Phone calls and other correspondence are not proof of timely filing. What if I contacted the Department or fiscal agent and I am still waiting for a response? Waiting for prior authorization or correspondence from the Department or the fiscal agent is not an acceptable reason for late filing. If there is an RA within the last 60 days, providers must reference the previous ICN. Can I attach a copy of my Remittance Advice (RA) as a timely extension? No. The fiscal agent does not accept attachments via batch submissions. Attachments should be submitted with the claim via the Provider Web Portal. Providers must enroll and submit claims within 365 days from the DOS.Ĭlaims that are not able to be submitted within the 365-day guideline, but have one (1) of the above documents attached to the submission will be put into suspended status and will be reviewed by the fiscal agent.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |