Ordinarily, claims for HI benefits for covered services received during the 12- month
period ending September 30 of any year must be filed on or before December 31 of the
next year. Equitable relief does not apply to premium-free HI.
However where administrative error causes failure of a provider of Part A services
to file a request for payment within the usual time limit, the time limit may be extended.
The extension will end with the last day of the sixth month following the month in
which the error is rectified and notice is sent.
Therefore, special language may be required for notices of awards or reinstatements
of HI entitlement involving retroactive months. This would occur where the usual claims
filing time limit for services furnished in any of those months has ended (or will
end within 6 months after the month of notice). The language should be similar to
“If you received any services covered by Medicare during the period before October
1, (year), hospital benefits for such services can be paid only if the provider which
furnished the services submits a claim for payment on or before (the last day of the
6th month after the date of the notice). You should telephone your local social security
office if you have any questions regarding this matter.”
This language is in addition to any language required under HI 00805.195 or HI 00805.215 concerning the individual’s right to elect retroactive SMI entitlement. Language
concerning SMI services for which the usual claims filing time limit has expired is
sent only after an individual elects retroactive SMI entitlement in response to the
initial award or reinstatement notice.