New Mexico Medicaid: Claims Secondary to a Primary Payer: Timely Filing Denials

When the provider can document that a claim was filed with another primary payer including Medicare, a HSD contracted MCO (when Medicaid fee for service should have been billed instead), Medicare replacement plans, or another insurer, the claim must be received by Conduent within 90 calendar days of the date the other payer paid or denied the claim as reported on the explanation of benefits or remittance advice of the other payer, not to exceed 210 calendar days from the date of service. It is the provider’s responsibility to submit the claim to another primary payer within a sufficient timeframe to reasonably allow the primary payer to complete the processing of the claim and also meet the MAD timely filing limit.

If you have claims that were submitted within the 90 day limit from the primary insurance’s payment date but denied for timely filing due to the 210 day final filing limit policy AND you have proof the claims were submitted to the primary insurance within 90 days of the date of service AND either a delay in processing the claim or appeals and reconsideration requests caused the claim to exceed the 210 day final filing limit the claims can be resubmitted with a reconsideration request. For each claim submit an original red claim form and attach a reconsideration request with explanation of the circumstance that caused the delay and proof that the claim was submitted to the primary insurance within the above timeframe. (Note that the claim still must have been received and processed by Conduent within two years of the date of service, regardless of the payment issue with the primary payer.) The Medical Assistance Division (MAD) has advised that claims that exceed the 210 day final filing limit will otherwise not be considered for payment.

Reconsideration Request Form

The information for Timely Filing is found on page 4 under the 8.302.2.11 portion section A. (3): www.hsd.state.nm.us