Modifying the Timely Filing Exceptions on Retroactive Medicare Entitlement and Retroactive Medicare Entitlement Involving State Medicaid Agencies

CMS is revising the “Medicare Claims Processing Manual” to specify that, if a provider, supplier, or beneficiary is unable to provide the Medicare contractor with an official Social Security Administration (SSA) letter, the contractor must check the Common Working File (CWF) database in order to verify a beneficiary’s retroactive Medicare entitlement date. The “Medicare Claims Processing Manual” currently requires that, in order to be granted a timely filing extension, the provider, supplier, or beneficiary must furnish an official letter from the SSA to the beneficiary in order to meet one of the conditions that the beneficiary was retroactively entitled to Medicare on or before the date of the furnished service. This CR requires the Medicare contractors to accept the SSA letter or, in the absence of such letter, to check the CWF database for a beneficiary’s date of Medicare entitlement. Contractors may interpret the CWF data in order to verify retroactive Medicare entitlement that may permit a claim to be processed after the 12 month timely filing limit.