Fixed Fee For Service In Maryland
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FAQ
Providers must submit electronic or paper claims to MPC for reimbursement within one hundred eighty (180) days from the service date. For a claim on a CMS 1500 claim form, one hundred eighty (180) days are counted from the day the service was performed.
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. Submission of Claims: Participating and nonparticipating providers, 180 days from the date of service.
A claim correction may be submitted online via the Direct Data Entry (DDE) system.
Corrected claim must be received within 60 days of the last rejection. SOLUTION: Submit the claim through normal claims processing channels, including documentation of retroactive eligibility (IMA 81 –Notice of Retro eligibility). Claim must be received within 12 months of the eligibility decision date.
Billing Time Statute You must submit a clean claim to the Maryland Medical Assistance Program within 12 months of the date of service (for acute hospitals—date of discharge). A clean claim is an original, correctly completed claim that is ready to process. Submit claims immediately after providing services.
