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Medicaid will be enforcing the one year timely filing for claims.

An Important Memo from the Department for Medicaid Services

The Department for Medicaid Services (DMS) is reminding Nursing Facility Providers (PT12) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (PT11) of requirements related to timely filing. Per federal regulations, Medicaid must receive claims no more than 12 months from the date of service.

For claims 12 months old or more past the date of service to be considered for processing, the provider must submit documentation demonstrating timely receipt by DMS or Gainwell Technologies along with documentation of subsequent billing efforts.

For pending Medicaid members, aged claims may be considered for payment if filed within one year from the eligibility issuance date. A copy of the KY HealthNet card issuance screen must be attached to the paper claim.