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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-9. MEDICAID PROGRAM |
Section 29-900. TIME LIMITATION ON PAYMENT OF MEDICAID PROVIDER CLAIMS
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900.1A claim for Medicaid reimbursable services may be submitted electronically or on paper by the enrolled billing provider.
900.2Effective October 1, 2012, the Department of Health Care Finance (DHCF) shall not pay any claim submitted with a date of service that is greater than three hundred and sixty-five (365) days prior to the date of submission. All claims for services submitted after three hundred and sixty-five days (365) from the date of service shall be ineligible for payment.
900.3For an individual whose eligibility has been determined retroactively, the timely filing period begins on the date of the eligibility determination.
900.4Where an initial claim is submitted within the timely filing period but is denied and resubmitted subsequent to the end of the timely filing period, the resubmitted claim shall be considered timely filed provided it is received within three hundred and sixty-five (365) days of the denial of the initial claim.
900.5If a claim for payment under Medicare has been filed in a timely manner, DHCF may pay a Medicaid claim relating to the same services within one hundred and eighty (180) days after DHCF or the provider receives notice of the disposition of the Medicare claim.
900.6The date of submission shall be the date the agency receives the claim, as defined by the Transactional Control Number (TCN) assigned to each claim.
900.7The provisions in this Chapter shall apply to all providers who submit claims to DHCF for adjudication.