Maryland Medicaid Timely Filing Limit

Time Limits For Submissions and Resubmission of Claims to HealthChoice Managed Care Organizations and their Behavioral Health Organizations

Information Provided by MCOs and BHOs

Amerigroup
Submission of Claims: 180 days to submit clean claims.

Diamond Plan form Coventry (Managed by United Behavioral Health)
Submission of Claims:

• Participating providers, 180 days from the date of service.
• No time limit for non-participating providers
  Resubmissions:
• Participating providers, 365 days, as long as no more than 18 months from the date of service. Timely filing is waived with retroactive authorizations and if the claim was denied incorrectly by UBH.
• Non-participating providers, 365 days, as long as no more than 18 months from the date of service

Helix Family Choice (managed by United Behavioral Health)

Submission of claims:
• Participating providers, 180 days from the date of service.
• No time limit for nonparticipating providers
Resubmissions:
• Participating providers, 365 days, as long as no more than 18 months from the date of service. Timely filing is waived with retroactive authorizations and if the claim was denied incorrectly by UBH
– Non-participating providers, 365 days, as long as no more than 18 months from the date of service.

Jai Medical Systems
Submission of Claims:

• Jai is primary insurance: 180 days from the date of service.
• If Jai is secondary insurance: 180 days from the payment/denial from the primary insurance.
  Resubmission: 180 days from the Explanation of Payment date to appeal the claim.

Maryland Physician Care
Submission of Claims:
All encounter and claims must be submitted within 180 days of encounter. MPC, as a Medicaid MCO, is a payer of last resort. Bill the primary insurance first then submit the claim for the remainder to MPC with a copy of the primary carrier’s EOB. Primary insurance’s EOB must include explanation for any denied charges. If there are problems getting the claim paid correctly due to COB issues. contact your Provider Representatives.

Resubmission:
• To submit a corrected claim or missing attachment, return the claim, stamped “Resubmission” with requested change(s), corrected errors, and requested attachments to the claims address below, ATTN: “Resubmission” within 90 working days of the denial. Not clearly indicating “Resubmission” may result in further delays.
• To appeal a claim denial, submit a letter of explanation, copy of remittance advice, MPC denial letter and other documentation relevant to the reason for the denial to the 509 Progress Drive Suite 117 Linthicum, Maryland 21090 address below, ATTN: “Grievance and Appeals Coordinator” within 90 working days of the receipt of a preauthorization or claim denial.

Priority Partners
Submission of Claims: 180 days of the date of service.
Resubmission: Administrative Appeals must be submitted within 90 working days of the date of the denial.

United HealthCare (Managed by United Behavioral Health)
Submission of Claims:
• Participating and nonparticipating providers, 180 days from the date of service.
Resubmissions:
• Participating providers, 365 days, as long as no more than 18 months from the date of the service. Timely filing is waived with retroactive authorizations and if the claim was denied incorrectly by UBH.
• Non-participating providers, 365 days, as long as no more than 18 months from the date of service.