Original claims must be submitted within 12 months(365 days) of the month of services.
An original claim submitted after 12 months from the month of service without a DHCS approved Delay Reason Code (DRC) will be denied.
Workflow
Generate a service in myAvatar, such as completing a progress note, entering information in Client Charge Input, or using compiled/roll up definition compiled/posted census.
In Quick Billing Rule Definition, enter the number of days (365) that will prompt the user to enter a Delay Reason Code.
In Electronic Billing, enter the number of days (365) that will prompt the user to enter a Delay Reason Code for each billing form.
Complete the required fields, and complete any other fields as appropriate.
Enter 365 for the Number of days from 'Date Of Service' to 'Date of Claim' in which the service requires a 'Delay Reason Code Assignment' in 2300-CLM-20. Note: The number of days should be equal to the timely filing requirement (365).
Complete all required fields. Fields relevant to this Claim Requirement are discussed in this section.
Select Medi-Cal for Type Of Bill. Note: The Timely filing rule does not change by billing forms or billing types.
The Date range of services is decided by the billing being run at that time.
Enter the First Date of Service to Include.
Enter the Last Date of Service to Include.
Enter 365 for the Number of Days from ‘Date of Service’ to ‘Date of Claim’ in which the service requires a ‘Delay Reason Code Assignment’ in 2300-CLM-20. Note: This value controls timely filing notification. The '365' complies with the 5.8.0 Billing requirement.
