If a claim was timely filed originally, but Cigna requested additional information.In general, Medicare does not consider a situation where (a) Medicare processed a claim in accordance with the information on the claim form and consistent with the information in the Medicare's systems of records and (b) a third party mistakenly paid primary when it alleges that Medicare should have been primary to constitute "good cause" to reopen. After one year and prior to four years from the date of determination, "good cause" is required for Medicare to reopen the claim. An initial determination on a previously adjudicated claim may be reopened for any reason for one year from the date of that determination. If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period.If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB).
#Past timely filing full#
However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. Medicare (Cigna for Seniors): In accordance with Medicare processing rules, non-participating health care providers have 15 to 27 months to file a new claim.In Coordination of Benefits situations, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefits (EOB) or explanation of payment (EOP).Provider agreement specifically allows for additional time.
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