5.1.6 Claims Filing Deadlines

For claims payment to be considered, providers must adhere to the following time limits. Claims received after the following time limits are not payable because the CSHCN Services Program does not provide coverage for late claims.

•	Inpatient claims filed by a hospital must be submitted to TMHP within 95 days from the discharge date. Hospitals may submit interim claims before discharge. These claims must be submitted to TMHP within 95 days from the last date of service on the claim.

•	Outpatient hospital services must be submitted to TMHP within 95 days from the date of service.

•	For clients receiving retroactive eligibility, TMHP must receive claims within 95 days from the date the eligibility was added to the TMHP eligibility file (add date).

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Claims for clients with other group or private health insurance coverage must be received by the CSHCN Services Program within 95 days of the date of disposition by the other third-party resource (TPR) and no later than 365 from the date of service. A copy of the disposition must be submitted with the claim and mailed to TMHP.

If more than 110 days have elapsed from the date a claim was filed with the TRP and no response has been received, the claim may be submitted to the CSHCN Services Program for consideration of payment. Claims must be submitted with documentation indicating the TPR has not responded.

Refer to:

Section 5.2, “Third-Party Resource (TPR),” on page 5‑8.

•	TMHP must receive claims from out-of-state providers within 365 days of the date of service.

•	All other claims must be submitted to TMHP within 95 days from each date of service.

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When a service is a benefit of Medicare, Medicaid, and the CSHCN Services Program, and the client is covered by all programs, the claim must be filed with Medicare first, then with Medicaid. If a Medicaid claim is denied or recouped for client ineligibility, the claim may be submitted to the CSHCN Services Program within 95 days from the date of Medicaid disposition.

When a filing deadline falls on a weekend or holiday, the filing deadline is extended to the next business day following the weekend or holiday. Holidays that may extend the deadlines in 2012 and 2013 are:

Date	Holiday
January 2, 2012*	New Year’s Day (federal holiday)
January 16, 2012	Martin Luther King, Jr. Day
February 20, 2012	Presidents Day
May 28, 2012	Memorial Day
July 4, 2012	Independence Day
September 3, 2012	Labor Day
October 8, 2012*	Columbus Day (federal holiday)
November 12, 2012*	Veteran’s Day (federal holiday)
November 22, 2012	Thanksgiving Day
November 23, 2012	Day After Thanksgiving
December 24, 2012	Christmas Eve Day
December 25, 2012	Christmas
December 26, 2012	Day After Christmas
January 1, 2013	New Year’s Day
January 21, 2013	Martin Luther King, Jr. Day
February 18, 2013	Presidents Day
May 27, 2013	Memorial Day
July 4, 2013	Independence Day
* Federal holiday, but not a state holiday. The claims filing deadline will be extended for providers because the Post Office will not be operating on this day.