Date of Initial Determination Notice: Timely Filing Limit:
310.2 - Time Limit for Filing a Request for Redetermination(Rev. 1986, Issued: 06-11-10, Effective: 10-01-10, Implementation: 10-01-10)
A party must file a request for redetermination within 120 days of the date of receipt of the notice of initial determination (MSN or RA) with the contractor indicated on the notice of initial determination. The date of filing for requests filed in writing is defined as the date received by the appropriate contractor in the corporate mailroom, the date received via facsimile, or the date received in the secure Internet portal/application. If the party has filed the request in person with the contractor, the filing date is the date of filing at such office, as evidenced by the receiving office's date stamp on the request. If the party has mailed the request for redetermination to CMS, SSA, RRB office, or another contractor or Government agency within the time limit, and the request did not reach the appropriate contractor until after the time period to file a request expired, the contractor considers good cause for late filing. (See §240 for more information on good cause.) Likewise, if the request is filed with CMS, SSA, RRB, or another contractor or Government agency in person, the contractor considers good cause for late filing.
The contractor may extend the period for filing if it finds the party had good cause for not requesting the redetermination timely. (See §240.2 for a discussion of good cause.) In order for good cause to be considered, the appeal request must be in writing, received via hard copy mail, through a facsimile, or through a secure Internet portal/application. If the contractor finds that the party did not have good cause for failing to request a redetermination in a timely manner, it may, at its discretion, consider reopening. (See Pub. 100-04, chapter 34.)
For Dates of Service on or After January 1, 2010, the claim must be filed within one calendar year after the date of service.
70.1 - Determining Start Date of Timely Filing Period -- Date of Service(Rev. 2140, Issued: 01-21-11, Effective: 01-01-10, Implementation: 02-22-11)
In general, the start date for determining the 12 month timely filing period is the date of service or "From" date on the claim. For institutional claims (Form CMS-1450, the UB-04 and now the 837 I or its paper equivalent) that include span dates of service (i.e., a "From" and "Through" date span on the claim), the "Through" date on the claim is used for determining the date of service for claims filing timeliness. Certain claims for services require the reporting of a line item date of service. For professional claims (Form CMS-1500 and 837-P) submitted by physicians and other suppliers that include span dates of service, the line item "From" date is used for determining the date of service for claims filing timeliness. (This includes DME supplies and rental items.) If a line item "From" date is not timely but the "To" date is timely, contractors must split the line item and deny the untimely services as not timely filed. Claims having a date of service on February 29 must be filed by February 28 of the following year to be considered timely filed. ...