AETNA MEDICARE TIMELY FILING PLUS

AETNA MEDICARE TIMELY FILING PLUS

Outcome– The claimant has until the end of the National Emergency, plus 60 days to file the appeal. The end of the 180-day timeline is March 1, 2020. Situation – The adverse decision is received by the claimant on Sept. Because the timeline for appealing expired before the effective date of these DOL guidelines, the normal timeframes apply, and the appeal submitted on March 24, 2020, is not timely. Outcome– The rules to suspend the timeline for appealing a decision do not apply because the appeal should have been filed by Nov. The claimant files an appeal on March 24, 2020. Situation – The adverse decision is received by the claimant on June 1, 2019. Until further notice, we will accept as timely all valid appeals of adverse benefit notifications dated on or after Sept. In compliance with the guidelines, the period from March 1, 2020, to 60 days after the announced end of the National Emergency will not count towards the deadline to submit an appeal.

The 180-day timeline for appealing an adverse benefit determination on a claim has been suspended as well. Outcome – If the National Emergency were over on June 1, 2020, the 180-day timeline to file this claim would start 60 days later, on July 31. Situation (assume 180-day timely filing rule) – The date of service was March 1, 2020. On July 31, one day remains to file the claim. If the National Emergency were over on June 1, 2020, 60 days later is July 31, 2020. Outcome – The time to file this claim is suspended starting on March 1, 2020, until 60 days after the National Emergency is declared over. The claim entered day 179 of the 180-day timeline on Feb. Situation (assume 180-day timely filing rule) – Service was rendered on Sept.

Outcome – The rules to suspend timely filing do not apply. Situation (assume 180-day timely filing rule) – The time for a claim to fulfill the timely filing rule expired on Feb. Timely filing limits may vary by state, product and employer groups. To help providers and individuals meet timely filing rules, the period from March 1, 2020, to 60 days after the announced end of the National Emergency will not count towards timely filing requirements. The date within which claimants may file a request for external review after receiving an adverse determination.The date within which claimants may file an appeal of an adverse benefit determination.The date within which individuals may file a claim.What does this mean? In compliance with the guidelines, between March 1, 2020, and 60 days after the announced end of the National Emergency, the following periods and dates are suspended: We will follow these guidelines.Īpplies to: This is for members of all fully insured and self-funded groups that are regulated by the Employee Retirement Income Security Act. The Quality Improvement Organization will respond to you as soon as possible, but no later than 14 days after receiving your request for a second review.Federal Agencies Extend Timely Filing and Appeals Deadlines June 24, 2020Īs a result of the National Emergency declared on March 1, 2020, the Employee Benefits Security Administration, Department of Labor (DOL), Internal Revenue Service and the Department of the Treasury extended certain timeframes to ease the burden of maintaining benefits and compliance with notice obligations. You may ask for this review immediately, but must ask within 60 days after the day the Quality Improvement Organization said no to your Level 1 Appeal. Within 48 hours the reviewers will tell you their decision. If you miss the deadline for contacting the Quality Improvement Organization about your appeal, you can make your appeal directly to us instead. You must contact the Quality Improvement Organization to start your appeal no later than noon of the day after you receive the written notice telling you when we will stop covering your care. You can ask to change this decision so you're able to continue coverage. When your coverage for that care ends, we'll stop paying our share of the cost for your care. You’ll receive a 'Notice of Medicare Non-Coverage (NOMNC)' in writing at least 2 days before we decide it’s time to stop covering your care. (Usually, this means you’re getting treatment for an illness or accident, or you're recovering from a major operation.) Rehabilitation care as an outpatient at a Medicare-approved Comprehensive Outpatient Rehabilitation Facility (CORF).Skilled nursing care as a patient in a skilled nursing facility.You have the right to keep getting your covered services for as long as the care is needed to diagnose and treat your illness or injury if you’re getting:

Aetna medicare timely filing