Iowa Admin. Code r. 441-80.4

Current through Register Vol. 47, No. 11, December 11, 2024

Rule 441-80.4 - Time limit for submission of claims and claim adjustments

(1)Submission of claims. Payment will not be made on any claim when the amount of time that has elapsed between the date the service was rendered and the date the initial claim is received by Iowa Medicaid exceeds 365 days. The department shall consider claims submitted beyond the 365-day limit for payment only if retroactive eligibility on newly approved cases is made that exceeds 365 days or if attempts to collect from a third-party payer delay the submission of a claim. In the case of retroactive eligibility, the claim must be received within 365 days of the first notice of eligibility by the department.

(2)Claim adjustments and resubmissions. A provider's request for an adjustment to a paid claim or resubmission of a denied claim must be received by Iowa Medicaid within 365 days from the date the claim was last adjudicated in order to have the adjustment or resubmission considered. In no case will a claim be paid if the claim is received beyond two years from the date of service.

(3)Definition. For purposes of this rule, a claim is "received" when entered into the department's payment system with an action of pay, deny, or suspend. Any claim returned to the provider without such action is not "received."

Iowa Admin. Code r. 441-80.4

ARC 1155C, IAB 10/30/2013, effective 1/1/2014

Amended by IAB February 8, 2023/Volume XLV, Number 16, effective 4/1/2023