HFS and 180 Timely Filing Edits

July 1, 2013

Dear Providers:

The following communication alert was issued June 7, 2013. DMH is re-issuing it as a courtesy and reminder.

Per HFS, the 180 day timely filing edit as required by the SMART Act (Public Act 097-0689) will be turned on for DMH providers on August 1, 2013. This means that claims for dates of service provided on or after July 1, 2012 must be received by HFS no more than 180 days after the date of service or they will reject with error code G55. So for example, once the edit is implemented, if a claim is received by HFS on August 1, 2013 (Julian date 213) and the date of service is prior to February 2, 2013 (Julian date 033) the claim will reject G55. Here is how we arrived at the February 2nd date: August 1st = Julian date 213; day 213 MINUS 180 days = Julian Date 33; Day 33 on the Julian calendar is February 2, 2013. So claims received by HFS on 8/1/13 would have to be for DATE OF SERVICE February 2, 2013 or after, otherwise they will reject G55. The link provided by HFS to the Julian calendar tools below may be helpful for your calculations:

Appendix 4 of the Chapter 100 handbook, which is the Julian Date Calendar (including both perpetual and leap years), at: http://www.hfs.illinois.gov/assets/100app4.pdf or A Julian Date Calculator at: http://www.nr.com/julian.html

The 180 day timely filing limit edit applies to both original and re-submitted claims. Please note that if claims that exceeded the 180 day timely filing limit have already been received and adjudicated as clean claims by HFS prior to August 1, 2013 these claims will not be affected.

The timely filing edit for claims with dates of service prior to July 1, 2012 will be implemented on August 1st 2013 as well. Once this occurs, all claims with dates of service prior to 7/1/12 will reject. If you have any outstanding claims, please be sure to submit them so that there is adequate time for processing and adjudication prior to August 1st. If questions regarding the timely filing edits, please contact the HFS Bureau of Comprehensive Health Services at 877-782-5565; Press "0"; ask for a Community Mental Health Support Consultant.