Kan. Admin. Regs. § 129-5-65

Current through Register Vol. 43, No. 49, December 5, 2024

Section 129-5-65 - Filing limitations for medical claims

(a) Each provider shall submit all medical claims to the Kansas medical assistance program within 12 months from the date of service.

(b) Any provider may resubmit a denied claim for payment to the Kansas medical assistance program if the resubmission meets the following requirements:

(1) Is within 24 months from the date of service; and

(2) is in conformance with all billing requirements of the medicaid/medikan program.

(c) The Kansas medical assistance program shall reimburse only claims that are submitted in accordance with subsection (a) or with subsections (a) and (b).

(d) Each of the following claims shall be an exception to subsections (a) and (b) and shall be payable by the Kansas medical assistance program:

(1) Any claim that is submitted to medicare within 12 months from the date of service, is paid or denied for payment by medicare, and is subsequently received by the Kansas medical assistance program within 30 days from the date of medicare's payment or denial of payment;

(2) any claim determined by the Kansas health policy authority to be payable by reason of administrative appeals, court action, or agency error;

(3) any claim for emergency services rendered by an out-of-state provider who is not already enrolled as a program provider;

(4) any claim for services provided to a recipient that is submitted to the Kansas medical assistance program within 12 months from the date on which the agency issues a notice of action under K.A.R. 129-6-38; and

(5) any claim specified in paragraph (d) (1), (2), (3), or (4) that is not payable under that paragraph but that the Kansas health policy authority determines is the result of extraordinary circumstances.

Kan. Admin. Regs. § 129-5-65

Authorized by K.S.A. 2006 Supp. 75-7403 and 75-7412; implementing K.S.A. 2006 Supp. 75-7405 and 75-7408; effective July 13, 2007.