CMS urges 90-day billing for early Part D claims

March 20, 2006

Given the technical difficulties that led to lack of accurate beneficiary information during implementation of the Medicare Part D benefit, drug plans should let pharmacies submit claims that are up to 90 days old, according to the Centers for Medicare & Medicaid Services.

Given the technical difficulties that led to lack of accurate beneficiary information during implementation of the Medicare Part D benefit, drug plans should let pharmacies submit claims that are up to 90 days old, according to the Centers for Medicare & Medicaid Services.

At the beginning of February, pharmacies began to submit Part D claims or to resubmit claims that lacked correct billing information. Some of them were greeted with a nasty surprise as they ran up against 30-day billing limits placed on pharmacies and beneficiaries by some drug plans. They found out that the claims for scripts they had filled in early January were being rejected as too old because they exceeded the 30-day limit.

While thanking Rx plan sponsors for their willingness to work with CMS during implementation, Gary Bailey, deputy director for plan policy and operations in the Center for Beneficiary Choices at CMS, sent a memo on Feb. 4 asking plans not to implement 30-day billing limits placed on pharmacists and beneficiaries. "Instead, these edits should be relaxed to allow pharmacists to bill Part D plans for claims that are as old as 90 days," he said in the memo. "In addition, beneficiaries should have 90 days in which to provide documentation to the plan for any incorrect payments they may have made."