Service Agreement Provider Contract With Medicare In Hillsborough
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FAQ
In order to request an appeal of a denied claim, you need to submit your request in writing within 60 calendar days from the date of the denial. Please include with your request: A copy of the original claim.
Questions. Contact Benefits@HCFL or (813) 272-5130.
The Hillsborough County Health Care Plan (HCHCP) is a comprehensive managed care program for Hillsborough County residents with limited income and assets who do not qualify for other health care coverage, including Medicare and Medicaid.
& Timely Filing Requirements Claims must be submitted and received by the third party administrator from the network Management Service Organization (MSO) within 12 months from the date of service. Payments for claims received after 12 months from the date of service will be denied.
Exceptions to the 12-month claim submission time limit may be allowed, if the claim meets certain conditions. Providers must submit exceptional claims, along with the required Exceptional Claim Form, electronically via the Florida Medicaid Secure Web Portal under the Claims panel.
In medical billing, a timely filing limit is the timeframe within which a claim must be submitted to a payer. Different payers will have different timely filing limits; some payers allow 90 days for a claim to be filed, while others will allow as much as a year.
This section is completed by the Medicare carrier or A/B MAC. Individual practitioners subject to mandatory assignment are not required to sign a CMS-460. Exception: CMS-460 is needed when practitioners are forming a group or are incorporated.
This look-up tool is a searchable database that allows you to look up a provider by National Provider Identifier (NPI), or by name and location.
Voluntary Terminations A certified provider or supplier that wishes to terminate its agreement with Medicare must send a written notice of its intention to the CMS Survey & Operations Group (SOG) location, the state agency or the contractor within the timeframes addressed in § 489.52. Under CMS Publication (Pub.)
In summary, a provider, whether participating or nonparticipating in Medicare, is required to bill Medicare for all covered services provided. If the provider has reason to believe that a covered service may be excluded because it may be found not to be reasonable and necessary the patient should be provided an ABN.
