MO HealthNet Timely Filing Guidelines

MO HealthNet timely filing guidelines for claims and adjustments can be found in Section 4 of Provider Manuals.
  • Original claims must be filed by the provider and received by the state agency within twelve (12) months from the date of service. Any claims that originally were submitted and received within twelve (12) months from the date of service, but were denied or returned to the provider, must be resubmitted and received within twenty-four (24) months of the date of service.
  • Medicare/MO HealthNet crossover claims that have been filed within the Medicare timely filing requirement must be received by the state agency within twelve (12) months from the date of service or six (6) months from the date on the Medicare provider's notice of the allowed claim. Claims denied by Medicare must be filed by the provider and received by the state agency within twelve (12) months from the date of service.
  • MO HealthNet claims with third party liability must first be submitted to the insurance company in most instances. However, the claim to MO HealthNet must still meet the timely filing guidelines outlined above. Claim disposition by the insurance company after one (1) year from the date of service does not serve to extend the filing requirement. However, the twelve (12) month filing rule may be extended if a third-party payer, later reverses the payment determination sometime after twelve (12) months from the date of service has elapsed and requests the provider return the payment. In this case, the provider may file a claim with MO HealthNet later than twelve (12) months from the date of service by submitting the claim to the Third Party Liability Unit, P.O. Box 6500, Jefferson City, MO 65102 for special handling.
  • Adjustments to a paid claim must be filed within twenty-four (24) months from the date of the remittance advice on which payment was made. If the processing of an adjustment necessitates filing a new claim, the time limit for resubmitting the new, corrected claim is ninety (90) days from the date of the remittance advice indicating recoupment or twelve (12) months from the date of service, whichever is longer.

MO HealthNet provider manuals can be referenced through the following link: http://manuals.momed.com/manuals/.