Late Bill Override Date (LBOD) - Continued

Billing Instruction Detail - Retroactive Member Eligibility

Instructions -  The claim is for services provided to an individual whose Colorado Medical Assistance Program eligibility was backdated or made retroactive.

File the claim within 120 days of the date that the individual’s eligibility information appeared on state eligibility files. Obtain and maintain a letter or form from the county departments of social services that:

•  Identifies the patient by name 
•  States that eligibility was backdated or retroactive 
•  Identifies the date that eligibility was added to the state eligibility system.  

LBOD = the date shown on the county letter that eligibility was added to or first appeared on the state eligibility system.

Billing Instruction Detail - Delayed Notification of Eligibility

Instructions 

The provider was unable to determine that the patient had Colorado Medical Assistance Program coverage until after the timely filing period expired.

 File the claim within 60 days of the date of notification that the individual had Colorado Medical Assistance Program coverage.

Billing Instruction Detail - Delayed Notification of Eligibility 

Instructions 

• Retain correspondence, phone logs, or a signed Delayed Eligibility Certification form  that identifies the member, indicates the effort made to identify eligibility, and shows the date of eligibility notification.
• Claims must be filed within 365 days of the date of service. No exceptions are allowed.
• This extension is available only if the provider had no way of knowing that the individual had Colorado Medical Assistance Program coverage. 
• Providers who render services in a hospital or nursing facility are expected to get benefit coverage information from the institution. 
• The extension does not give additional time to obtain Colorado Medical Assistance Program billing information. 
• If the provider has previously submitted claims for the member, it is improper to claim that eligibility notification was delayed.

 LBOD = the date the provider was advised the individual had Colorado Medical Assistance Program benefits.

Billing Instruction Detail - Electronic Medicare Crossover Claims 

Instructions 

An electronic claim is being submitted for Medicare crossover benefits within 120 days of the date of Medicare processing/ payment. (Note: On the paper claim form (only), the Medicare SPR/ERA date field documents crossover timely filing and completion of the LBOD is not required.) 

File the claim within 120 days of the Medicare processing/ payment date shown on the SPR/ERA. Maintain the original SPR/ERA on file. 

LBOD = the Medicare processing date shown on the SPR/ERA.

Billing Instruction Detail - Medicare Denied Services 

Instructions 

The claim is for Medicare denied services (Medicare non-benefit services, benefits exhausted services, or the member does not have Medicare coverage) being submitted within 60 days of the date of Medicare processing/denial. 

Note: This becomes a regular Colorado Medical Assistance Program claim, not a Medicare crossover claim. 

File the claim within 60 days of the Medicare processing date shown on the SPR/ERA. Maintain the original SPR/ERA on file.

 LBOD = the Medicare processing date shown on the SPR/ERA.

Billing Instruction Detail - Commercial Insurance Processing  

Instructions 

The claim has been paid or denied by commercial insurance. 

File the claim within 60 days of the insurance payment or denial. Retain the commercial insurance payment or denial notice that identifies the patient, rendered services, and shows the payment or denial date.

Claims must be filed within 365 days of the date of service. No exceptions are allowed. If the claim is nearing the 365-day limit and the commercial insurance company has not completed processing, file the claim, receive a denial or rejection, and continue filing in compliance with the 60-day rule until insurance processing information is available. 

LBOD = the date commercial insurance paid or denied.

Billing Instruction Detail - Correspondence LBOD Authorization  

Instructions 

The claim is being submitted in accordance with instructions (authorization) from the Colorado Medical Assistance Program for a 60 day filing extension for a specific member, claim, services, or circumstances. 

File the claim within 60 days of the date on the authorization letter. Retain the authorization letter. LBOD = the date on the authorization letter.

Billing Instruction Detail - Member Changes Providers during Obstetrical Care  

Instructions 

The claim is for obstetrical care where the patient transferred to another provider for continuation of OB care. The prenatal visits must be billed using individual visit codes but the service dates are outside the initial timely filing period. 

File the claim within 60 days of the last OB visit. Maintain information in the medical record showing the date of the last prenatal visit and a notation that the patient transferred to another provider for continuation of OB care.

 LBOD = the last date of OB care by the billing provider