Medicare_Carriers_Manual / 3041 / 3041

Why This Topic Matters

It addresses claim filing compliance, late-submission consequences, and related processing steps that can affect payment, beneficiary liability notices, and claims system reporting.

Article Sections

1. Ed. Note: For further information see

   Cross-references to related manual chapters and topics that provide additional background on claims filing, deadlines, equipment rental dates, CMS-1500 instructions, and participation status.

2. 3041. Physician and Supplier Billing Requirements for Services Furnished on or After 9/1/90

   Overview of Medicare Part B filing requirements for physicians and suppliers, including timing, late submission handling, and related compliance considerations.

3. A. General

   General policy framework for filing claims within the required time period and the consequences associated with delayed submission.

4. B. Medicare Secondary Payer (MSP) Claims

   Guidance on handling claims when other insurance may be primary and Medicare acts as the secondary payer.

5. C. Good Cause

   Discussion of when the filing deadline may be extended based on a good-cause determination.

6. D. Conditions Which Establish Good Cause

   Categories of circumstances that may support a good-cause finding for late claim filing.

7. E. Procedure to Establish Good Cause

   Procedural guidance for evaluating statements or evidence related to delayed filing and applying the appropriate claim processing outcome.

8. F. Good Cause Is Not Found

   Processing steps used when a late-filed claim does not qualify for good-cause treatment, including beneficiary notice handling.

9. G. Preparing Common Working File (CWF) Claim Records for Services Subject to 10 Percent Payment Reduction

   Instructions for preparing claim records in the CWF when late-filing payment adjustment rules apply, including required field entries and multiple-payment-rule coordination.