Exceptions for Late Filing

We allow 4 exceptions to the timely filing requirement, including:

• Administrative error, if failure to meet the filing deadline was caused by error or misrepresentation of an employee, Medicare contractor, or agent of the department that was performing Medicare functions and acting within the scope of its authority
• Retroactive Medicare entitlement where a patient gets notification of Medicare entitlement retroactive to or before the date of service
• Retroactive Medicare entitlement involving State Medicaid Agencies where a State Medicaid Agency recoups payment from a health care professional or supplier 6 months or more after the date of service for a dually eligible patient
• Retroactive disenrollment from an MA Plan or Program of All-Inclusive Care for the Elderly (PACE) organization where a patient enrolled in an MA Plan or PACE organization is later disenrolled from the MA Plan or PACE organization retroactive to or before the date of service, and the MA Plan or PACE organization recoups its payment from a health care professional 6 months or more after the date of service

For more information, refer to the Medicare Claims Processing Manual, Chapter 1.