PM 20-04-01-c: Billing

WAG 20-04-01-c.

To bill HFS, providers must complete forms provided by HFS. To be paid, providers must submit:

  • Revised textmost bills for service within 180 days of providing service;
  • Revised textMedicare cross-over claims (bills covered by Medicare and the state) within 24 months of date of service;
  • Revised textLTC admissions within 5 working days of admission to the facility through the Medical Electronic Data Interchange (MEDI) or the Recipient Eligibility Verification (REV) system. Supporting documentation, such as income verification records, must be submitted to the FCRC within 30 days.

The time limit for bill submission also applies to claims resubmitted after rejection by HFS.

NOTE: Bills can be submitted later than 12 months because of a court order or an appeal decision.

The provider's signature on the form confirms:

  • the service was provided by the provider requesting payment;
  • no payment or only partial payment has been received;
  • the bill is the complete charge for the service; and
  • the provider will not bill or accept payment from anyone else for the service, if the provider knew the customer was eligible for medical benefits. This includes seeking additional payment from the customer, except for any required copayment.

When a provider contacts the FCRC about a billing question or problem, refer the provider to the appropriate provider manual.