Timely Filing Update April 2024

Effective 4/1/2024 – Inclusa to 120 days for clean claims.

CLAIMS MUST MEET THE FOLLOWING PARAMETERS

  1. The claim is submitted to Wisconsin Physicians Services (WPS),Inclusa’s third party claims processer on or after 4/1/2024.  See below examples:
    1. 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.
  2. The claim meets the following definitions:
    1. 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.
    2. 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.
  1. 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.