Identification Number:
EM-12052
Intended Audience:RCs/ARCsMOS/FOs/TSCs/SPIKES/PSCs/
OCO-CSTs/OTS/OPB
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Time Limit for Filing Claims for Medicare Part A and Part B Services
Type:EM - Emergency Messages
Program:Medicare
Link To Reference:See References at the end of this EM.
 
New Retention Date: July 07, 2017

Retention Date: January 7, 2017
Retention Date: July 7, 2016
Retention Date: January 7, 2016
Retention Date: July 7, 2015
Retention Date: January 7, 2015
Retention Date: December 7, 2013

A. Purpose of the emergency message
This EM advises SSA of the change to the time limit for filing Medicare Part A and Part B claims. It also revises the SMID Universal Text Identifier (UTI) and obsoletes AM-09126 REV, Notice Language for Filing Medicare Part A/Part B Claims for Services.

B. Policy for time limit
Effective January 1, 2010, providers must file any Medicare Part A and Part B claims for services to the appropriate claims processing contractor no later than 12 months (or one calendar year) after the date of service.

The time limit is extended in the following situation:
    • Part A and/or Part B entitlement does not exist at the time the service was furnished, and
    • the beneficiary receives notice of Part A or Part B entitlement after the date of service.

The extension ends with the last day of the sixth month following the month in which the beneficiary receives notice of Part A or Part B entitlement. Special language is required for notices of Part A or Part B awards or reinstatements involving retroactive months. Include UTI SMID in the notice of award or reinstatement when the time limit for filing claims for services furnished in any of the retroactive months has expired or will expire within six months after the month of notice.

C. Revised SMID UTI
For Medicare services received before *F1, Medicare *F2 benefits may be paid only if the service provider submits a claim on or before *F3. Please give your providers a copy of this letter; ask them to include a copy of this letter when submitting these claims to Medicare.
    Fill-ins:
    *F1 – MMDDCCYY- first day of the 5th month prior to the month of notice of Part A, Part B, or Part A and Part B entitlement (Example: if the award notice is sent in May 2011, the fill-in is December 1, 2010).
    *F2 – 1 Part A
    *F2 – 2 Part B
    *F2 – 3 Part A and Part B
    *F3 - MMDDCCYY – last day of the 6th month following the month of notice (Example: if the award notice is sent in May 2011, the fill-in is November 30, 2011).

The SMID UTI is in addition to any notice language required under HI 00805.195 or HI 00805.215 concerning the individual’s right to elect retroactive Part B entitlement. Include the SMID UTI in the notice only after an individual elects retroactive Part B entitlement in response to the initial award or reinstatement notice and the time limit for filing Part B claims has or will expire within 6 months of the notice of SMI entitlement.

D. Example of retroactive Part A award
SSA processes Mr. Casey’s disability claim on 01/15/2012 (COM 01/2012). Monthly benefits are payable effective 03/2009 and Part A begins 03/2011. Equitable relief applies and Part B coverage is effective 01/2012. The award notice offers Mr. Casey the option of choosing Part B coverage retroactive to 03/2011. In addition, the notice must include the SMID UTI to advise him that the provider must file Part A claims for services furnished before August 1, 2011, no later than July 31, 2012.

For Medicare services received before August 1, 2011, Medicare Part A benefits may be paid only if the service provider submits a claim on or before July 31, 2012. Please give your providers a copy of this letter. Ask them to include a copy of this letter when submitting these claims to Medicare.

E. Example of retroactive Part B award
In March 2012, SSA receives Mr. Casey’s request for Part B coverage retroactive to 03/2011. The Part B award notice dated March 21, 2012, includes the SMID UTI to advise Mr. Casey that the provider must file Part B claims for services furnished before October 1, 2011, no later than September 30, 2012.

Direct all program-related and technical questions to your RO support staff or PC OA staff. RO support staff or PC OA staff may refer questions or problems to their Central Office contacts.

References:
HI 00805.185F Part A Time Limit
HI 00805.195C.6 Notice of Time Limit for Claims Reimbursement
HI 00805.215 SMI Terminated Erroneously
NL 00730.020 Notice Documentation
EM-12052 - Time Limit for Filing Claims for Medicare Part A and Part B Services - 12/31/2012