Time requirement for Part B submission to Medigap.

[LostDollar]

I read that Part B providers have 1 year from date of service to submit their claim to CMS.

Does the same time limit apply for Part B providers submitting directly to Medigap?

 

[goillini52]

I read that Part B providers have 1 year from date of service to submit their claim to CMS.

Does the same time limit apply for Part B providers submitting directly to Medigap?

Part B providers aren't supposed to file with the Med Supp carrier.

 

[Yagents]

I'm surprised by that question from you LD. ??

Penalty box for you.

 

[Midlevel]

I'm surprised by that question from you LD. ??

Penalty box for you.

Bet he’s referring to the Foreign travel benefit.

 

[sshafran]

I'm surprised by that question from you LD. ??

Penalty box for you.

You have not read file CMS 345.4(redacted) via fisa warrant like he has, which left this question open ended.

Hence his merited post.

 

[Yagents]

I have all 125 CMS volumes near my bed,........which is next to the Bible, and biden's budget

 

[LostDollar]

Part B providers aren't supposed to file with the Med Supp carrier.

Some can, and do.

I can't get any further than that with searching. I can find info on time to file with CMS, but not Medigap.

I think the answer to my question is yes, but I can't be sure, just thought I would ask here.

This is not a theoretical question, I'm trying to prepare the "right" response for " in-case a Part B provider presents me with bills that have not been processed by Medigap".

Just so you don't think I am making stuff up, here is an article from a California organization showing the three ways claims can be submitted to Medigap:

Your Medigap (supplemental insurance) company or retiree plan receives claims for your services 1 of 3 ways:

1. Directly from Medicare through electronic claims processing. This is done online.
2. Directly from your provider, if he/she accepts Medicare assignment. This is done online, by fax or through the mail.
3. From you. If neither Medicare nor the provider submits the claim, you will need to file the claim yourself. Follow these steps:
   • Fill out the claim form provided by your insurance company (if required).
   • Attach copies of the bills you are submitting for payment (if required).
   • Attach copies of the MSN related to those bills.
   • Make copies of everything for your personal records.
   • Mail your claim packet to the Medigap company or retiree plan

https://cahealthadvocates.org/billing-claims/how-medicare-part-a-b-claims-are-processed/


I just can't get any further to show:

The time limits for initial submission of claims to Medigap

and

Whether the Medigap submission time limits might be extended if the Medigap plan refuses to process a claim because it is submitted incorrectly.

 

[goillini52]

Some can, and do.

I can't get any further than that with searching. I can find info on time to file with CMS, but not Medigap.

I think the answer to my question is yes, but I can't be sure, just thought I would ask here.

This is not a theoretical question, I'm trying to prepare the "right" response for " in-case a Part B provider presents me with bills that have not been processed by Medigap".

Just so you don't think I am making stuff up, here is an article from a California organization showing the three ways claims can be submitted to Medigap:



https://cahealthadvocates.org/billing-claims/how-medicare-part-a-b-claims-are-processed/


I just can't get any further to show:

The time limits for initial submission of claims to Medigap

and

Whether the Medigap submission time limits might be extended if the Medigap plan refuses to process a claim because it is submitted incorrectly.

Call your Med Supp company and ask them.

 

[Russ]

I've seen a company or 2 years ago... stating a one-year limit from DOS on Medicare claims. But not recently.

 

[kgmom219]

Assuming you are talking about Excess Charges and the provider will not file the claim, its 12 months from Date of Service.

But not sure if the 12 months is TX or Federal, either.