Peoples Health policy is to follow CMS regulations and any other CMS guidance regarding claims filing deadlines. CMS rules on filing timely claims state that:
- Claims must be received within 12 months (365 days) from the date of service.
- For inpatient admissions, claims must be received within 12 months (365 days) from the date of discharge.
- Exceptions to CMS rules and regulations
We will deny claims that are not filed in accordance with these CMS guidelines. We determine whether a claim has been received in a timely manner by comparing the date the services were rendered to the receipt date applied to the claim when it is received. Corrected claims must be resubmitted and received by Peoples Health within the timely filing period.
In accordance with your provider agreement, providers shall bill Peoples Health for all covered services rendered to our plan members, less any coinsurance, copay or deductible collected or to be collected from the plan member. For medical management purposes, providers shall make a best effort to submit within 60 days following the provision of the services a complete statement (by services and charges) for the covered services provided to the plan member. However, failure of the provider to submit said written statement within 60 days of service delivery shall not, in and of itself, result in nonpayment.