CMS mandates 180-day Part D claims

May 15, 2006

CMS has mandated that Part D drug plans allow 180 days for filingclaims incurred between Jan. 1 and June 30. Problems withcoordination of benefits have required the reversal of claims andrebilling to the appropriate payer. Since a lack of information ledpharmacies to sometimes bill the wrong payer, they should not beheld to the usual 30- to 90-day timely billing standard, CMSconcluded.

CMS mandates 180-day Part D claims

CMS has mandated that Part D drug plans allow 180 days for filing claims incurred between Jan. 1 and June 30. Problems with coordination of benefits have required the reversal of claims and rebilling to the appropriate payer. Since a lack of information led pharmacies to sometimes bill the wrong payer, they should not be held to the usual 30- to 90-day timely billing standard, CMS concluded. The agency mandated the 180-day window after some Part D plans failed to create appropriate claims filing rules as CMS had requested.

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