1) When Vermont Medicaid is Primary the timely filing limit is 6 months (one of the shortest in the nation):
When the system indicates that Vermont Medicaid is the primary payer, the timely filing
limit for such claims is six months from
the date of service. In no case will a claim be
considered if the date of service is greater than two years prior to the DVHA’s receipt of
the claim. If a claim has a date or dates of service past the timely filing limit, it may be
submitted for payment directly to HPES if one or more of the following conditions are
met:
•HPES denied the claim within the timely filing limit for a reason other than
exceeding the
time limit. A copy of the remittance advice showing the denial must be
attached to each
claim.
•Abeneficiary’s eligibility was made retroactive and the date of service is within the
retroactive period. The claim must be submitted within the first twelve months of
thedate on the Notice of Decision. Include a note with the claim stating the
retroactivedate
of eligibility.
•Inpatient claim, the timely filing limit is 180 days from the date of
discharge.
2) Crossover Claims-you have 2 years (weird but true):
When a claim is billed to Medicare with Vermont Medicaid noted as the secondary payer
(using the crossover function), the crossover claim will be
considered timely if it is
received within two years of the date of service.
opticXpress specializes in Medicare and Medicaid billing for optometrists. We also handle the billing of ALL other insurance companies as well, espescially our home state of Vermont.
