Timely Filing Requirements Medicare will reject or deny claims which have not been filed within the time requirements specified by the program. Claims filed after the timely filing period are typically not eligible for appeal. Because the claim was filed after the timely filing period, Medicare does not make an "initial determination" on the claim. Due to no "initial determination" being made, the denial is not appealable. A redetermination request should not be filed in appeals for a timely filing denial. In certain circumnstances, all is not lost. There are times a timely filing extension can be granted. Timely Filing Extension There are 4 circumstances when a timely filing extension may be granted by Medicare: Administrative Error by Medicare Retroactive Benefit Entitlement Retroactive Entitlement Due to State Medicaid Retroactive Disenrollment from Medicare Advantage Plan or PACE program Let's look at each of these scenarios. Administrative Error b...
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