![]() ![]() Claims must be received within 120 days, post-date-of-service unless otherwise specified by the applicable participation agreement.For override information refer to the rebilling instructions posted on the webpage, or contact a billing consultant at 87 in the absence of notification on the webpage.EmblemHealth would like to remind providers of our timely filing requirements for claims submissions: Errors attributable to the Department or any of its claims processing intermediaries that results in an inability to receive, process or adjudicate a claim – the180 day period shall not begin until the provider has been notified of the error by either the date on the paper voucher/remittance advice or the fix date on the Claims Processing System Issues webpage.Claims may be submitted electronically or on the paper HFS 1443. Local Education Agencies (LEAs) – Claims must be submitted to the Department within 18 months from date of service.TPL fields on the paper claim must be completed when applicable. Attach a copy of the recoupment notification letter and form HFS 1624, Override Request Form, stating the reason for the override to a paper claim form. Primary TPL Recoupment – Claims must be submitted within 180 days from the date of the recoupment notification letter.Replacement or Void/Rebill of an entire claim or single service line – The Department will accept electronic transactions submitted through MEDI or via 837P files to void or replace a paid claim (includes claims paid at $0), or a claim that is pending to pay, if submitted within 12 months from the original paid voucher date.Attach a HFS 1624, Override Request Form, stating the reason for the override to a paper claim form. Please ensure eligibility verification is for the date of service and not current date or date range. Retroactive Participant eligibility – 180 days from the Department’s system update viewed on MEDI when verifying eligibility. ![]() Requests for override due to a provider file change must be requested within 180 days of a claim rejecting due to the discrepancy. Upon receipt of claims with an override request, HFS staff will verify that the claim(s) could not have been billed without the change to the provider file. Attach form HFS 1624, Override Request, stating the reason for the request to a paper claim form. The 180 day period shall begin with the date the enrollment, re-enrollment, or update was recorded on the provider file.
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