Timely Filing Update April 2024
Effective 4/1/2024 – Inclusa to 120 days for clean claims.
CLAIMS MUST MEET THE FOLLOWING PARAMETERS
- The claim is submitted to Wisconsin Physicians Services (WPS),Inclusa’s third party claims processer on or after 4/1/2024. See below examples:
- WPS receives a claim on 4/1/24 for dates of service 12/4/23: The claim will be paid based on the 120-day timeline being implemented on 4/1/24.
- The claim meets the following definitions:
- Clean Claim – a complete and accurate claim in which you have included all provider and member information necessary to process the claim, including all appropriate service and authorization codes.
- Filed Timely – claims must be received by WPS within 120 calendar days from the date of service or Primary Insurance Explanation of Benefits (EOB) date.
- WPS receives a claim on 3/31/24 for dates of service 12/4/23: The claim will be denied based on the current timeframe of 90-days.
Items to Note:
- The claim filing timeline does not end with the original claim submission.
- If a claim is rejected or denied in full, providers must correct all errors and submit as a new claim which must be received by WPS within the original 120 days from the date of service or the EOB remittance date.
- If a claim is partially paid (in dollars or units), a corrected claim must be completed and received by WPS within the original 120 days from the date of service or the EOB remittance date.