Humana Medicare Appeal: Timely Filing Limit

As healthcare providers, it's essential to understand the billing guidelines for submitting roster bills to Humana. One crucial aspect is meeting the timely filing limit when appealing a claim that was submitted in error to another carrier or agency. In this article, we'll explore the timeframes for submitting claims and provide valuable tips for healthcare providers.

When a claim is submitted in error to a carrier or agency other than Humana, the timely filing period begins from the date the provider was notified of the error by the other carrier or agency. This means that even if you're appealing a claim that was initially processed incorrectly, you still need to file your appeal within the designated time frame.

The timely filing limit varies depending on the type of service and provider. For physicians, claims must be submitted within 80 days from the date of service. Facilities and ancillary providers have a slightly longer window, with claims due within 110 days from the date of service. Medicare Advantage claims must be submitted within one calendar year from the date of service.

Commercial claims, on the other hand, follow the provider agreement or applicable state law regarding timely filing limits.

It's crucial for healthcare providers to keep track of these deadlines to avoid delays in payment and ensure smooth billing operations. Here are some additional tips to keep in mind:

* Always use the correct claim or encounter mailing address found on the member's identification card.

* Use electronic claim submission whenever possible to reduce administrative costs and improve cash flow.

* Make sure to include valid National Provider Identifiers (NPIs) on all electronic claims and strongly consider including them on paper claims.

By understanding the timely filing limit for Humana Medicare appeals, healthcare providers can avoid costly delays and ensure timely reimbursement. Remember to submit your claims promptly and follow the guidelines outlined above to maintain efficient billing operations.

Humana medicare appeal timely filing limit