Exceptions for Late Filing

We allow 4 exceptions to the timely filing requirement:

• 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 performed Medicare functions and acted within the scope of its authority.
• Retroactive Medicare entitlement where at the time the service was furnished, the Medicare patient wasn’t entitled to Medicare and subsequently gets notification of Medicare entitlement retroactive to or before the date of service.
• Retroactive Medicare entitlement involving State Medicaid Agencies where at the time you furnished the service, the Medicare patient wasn’t entitled to Medicare and later gets notification of Medicare entitlement retroactive to or before the date of service, and a State Medicaid Agency recoups payment from a provider or supplier 6 months or more after the date of service.
• Retroactive disenrollment from an MA Plan or Program of All-Inclusive Care for the Elderly (PACE) provider organization where at the time you furnished the service, the Medicare patient was enrolled in a MA plan or PACE provider organization. Then, they later disenrolled from the MA plan or PACE provider organization effective retroactively to or before the date of the furnished service. The MA plan or PACE provider organization recovered its payment for the service the provider or supplier furnished 6 months or more after they furnished the service.

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