Fee-For-Service Payment Help

​Common Billing Mistakes

Avoid these common billing errors to help ensure timely payment:

1. Identification missing or inaccurate for provider, participant or both.
2. Eligibility not established for claim dates of service for provider, participant or both.
3. Medical services not covered or authorized for the provider, participant or both.
4. Preauthorization required.
5. Claim is a duplicate, previously paid or a third party should pay the claim.
6. Documentation required to support claim not submitted.
   

For more information on common billing mistakes, see the CMS-1500 or UB-04 billing manual.

See your remittance advice and the explanation of benefits (EOB) code for specific claim denial explanation.

Exceptions to Timely Filing

A claim submitted after 12 months from the date of service or discharge will automatically deny except in the following cases:

1. Provider submitted the claim late due to retroactive eligibility determination or the claim was submitted timely and denied due to a retroactive eligibility issue
• Submit the claim within 12 months of the eligibility decision date
• Include the IMA 81 – Notice of Retro Eligibility documentation
2. The claim was denied due to an error originating in the State’s system
• Notify the designated unit within the Program of the error within 60 days of the date the error occurred
• Submit a clean claim within 12 months of the date the issue was rectified for that claim
3. Provider submitted the claim to Medicare or a third party as the primary payer
• Submit the claim within 120 days of the date of Medicare Explanation of Medicare Benefits (EOMB)
• Include a copy of the Medicare
  

When submitting these claims, include a cover letter explaining the reason for late submission along with the required documentation.

Other — Problem Claims

A problem claim is a request for payment that requires manual review because one or more of its properties conflicts with general billing rules – even though the provider correctly submitted a clean claim. More information is coming soon. 

Submit an Untimley or Problem Claim by Mail

• See Professional Provider Relations CMS-1500 
• See Institutional Provider Relations UB-04 
  

Resources

• Claims Troubleshooting 
• Coinsurance Worksheet
• Nursing Facility Provider page
• Transmittals
• PT 03-22 Timely Filing Requirements for Retroeligibility Submissions​
  

Contact

For assistance with a professional or an institutional claim, call the Provider Services Call Center​.​

Check Tracing 

The Check Tracing Unit assists Medicaid providers with missing, lost or stolen checks and can help with information about cancellation and payment replacement. 

Medicaid Provider Services is not responsible for the check re-issuance. 

Submit Check Tracing Request

Submit a request for check tracing by email to [email protected]

1. Include in the email subject line:
• Provider name or company name
• Type of check trace request, for example:
• Check reissue request 
• Missing check 
2. Include the following information in the email: 
• Provider ID number 
• Provider NPI 
• Invoice date 
• Invoice number 
• Check amount 
• Contact person 
• Contact telephone number 
• Federal/Tax ID number 
• W9 - must match all state files