AARP Medicare Timely Filing Limit: What You Need to Know

As a healthcare provider, it's essential to understand the timely filing limits for AARP Medicare claims. In this article, we'll break down what you need to know about submitting your claims on time.

Only specific inpatient services are used to calculate the stipulated threshold rate. This means that only covered services are included in the computation of the reinsurance threshold. If your claim falls under the reinsurance provisions set forth in your agreement with UnitedHealthcare West, make sure to follow the terms of the agreement.

When submitting claims for hospital providers, refer to Chapter 10: Our Claims Process for information about electronic claims submission and other EDI transactions. You can also mail paper CMS 1500 or UB-04s to the address listed on the member's ID card.

To avoid processing delays, it's crucial to validate your Payer ID number with your clearinghouse or refer to your clearinghouse published Payer Lists. In some cases, the Payer ID listed on EDI may be different from the numbers issued by your clearinghouse.

For a complete list of Payer IDs, refer to the Payer List for Claims. You can also submit your claims and encounters electronically using EDI transaction 837 or primary and secondary claims as EDI transaction 837.

UnitedHealthcare West encounters use the Payer ID 95958. OptumInsight Connectivity Solutions is also available to help you begin submitting and receiving electronic transactions. For information on EDI claim submission methods and connections, visit EDI 837: Electronic Claims.

Remember to refer to our online Companion Guides for the data elements required for these transactions found on EDI. You can also resubmit claims in the UnitedHealthcare Provider Portal at Sign In > Claims & Payments.

Finally, submit all professional and institutional claims and/or encounters electronically for UnitedHealthcare West and Medicare Advantage HMO product lines. Do not resubmit claims that were either denied or pended for additional information using EDI or paper claims forms.

EDI is the preferred method of claim submission for participating physicians and healthcare providers. By understanding the timely filing limits and submitting your claims correctly, you can ensure a smoother reimbursement process for your patients.

Aarp medicare timely filing limit