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INSUR {McGH}
TIME LIMITS & TIME LINES
| Term | Definition |
|---|---|
| 180 days | patient privacy complaints must be put in writing, either on paper or electronically, and sent to OCR within: |
| 60 calendar days | HITECH act requires the notifications to be made within ______ after discovery of the breach |
| 45 days | offices should respond to all RAC inquires because requests for information must be answered within: |
| 90 days | a BCBS HMO guest membership is a courtesy enrollment for members outside of their home HMO service area for at least: |
| 60 days | Medicare Part A coverage is tied to a benefit period of ______ for a spell of illness |
| 30 days | ADR's require the provider to respond within: |
| 30 to 60 days | claims that are denied may be appealed within a certain time period, usually: |
| 30 consecutive days | reserve and national guard personnel become eligible when on active duty for more than |
| 7 days | workers' comp cash benefits vary from state to state and are generally not paid for the first ____ of disability |
| 7 calendar days | in most states, a worker must be disabled for more than ____ before benefits are payable |
| 14 days | if the disability extends beyond ___ a worker may become retrospectively eligible for cash benefits for the 1st 7 days |
| 24 hours to 10 days (depending on state laws) | the first report of injury form must be filled within: |
| 30 to 45 days (depending on state laws) | insurance carriers must pay workers' comp claims within: |
| 90 and 180 days | time limit for filing claims is generally between ___ from the date of service |
| 14 days | clean electronic claims are paid within: |
| 45 calendar days | Medicare must process "other-than-clean" claims within: |
| 30 to 60 days | the participation contract often specifies a time period of ___ from claim submission |
| 7 to 14 days | most practices follow up on claims that are aged less than 30 days in: |
| 120 days | redetermination requests must be made within __ of receiving the initial claim determination |
| 60 days | the decision (MRN) must be made within __ and the letter is sent to both the provider and the patient |
| 180 days | reconsideration requests must be made within ___ of receiving the redetermination notice |
| 60 days | administrative law judge hearing must be requested within __ of receiving the reconsideration notice |
| 60 days | this appeals level must be requested within __ of receiving the response from the hearing by the admin law judge |
| 60 days | this review/hearing must be requested __ of receiving appeals board decision |
| 30 days | a provider must comply within __ or may be fined $100 per outstanding request by Medicare (itemized statement request) |
| three-day | Medicare bundles all outpatient services that a hospital provided to a patient within __ before admission into the DRG payment |
| 10 to 15 days | turnaround time for electronic claims is usually: |
| 45 days | RAC's must request records in writing, and providers have __ to respond |
| 1 year (from the date of discharge) | TRICARE Inpatient claims |
| 1 year (of the provided service date) | TRICARE Outpatient claims |
| 1 year (of the date of service or discharge | CHAMPVA Claims |
Created by:
VA_MedCod3r