Sec. 10.14.02.21. Billing and Reimbursement Time Limitations

A. The Program may not reimburse claims received for payment more than 12 months after the date of service except as specified in §§B-D of this regulation.

B. To obtain reimbursement from the Program, a health care provider that originally submits a claim to Medicare or another health insurer shall also submit the claim to the Program within a period whereby the Program receives the claim within the latter of:

(1) 12 months after the date of service; or

(2) 6 months from the Medicare or other health insurer remittance date as shown on the explanation of benefits.

C. The Program shall pay a claim that is originally rejected for payment due to improper completion or incomplete information only if:

(1) The health care provider properly completes and resubmits the claim to the Program; and

(2) The Program receives the resubmitted claim within the latter of:

(a) The original 12 month period from the date of service; or

(b) 6 months after claim rejection.

D. When the Program initially rejects a claim for payment in error, the Program shall pay the claim if the participating health care provider resubmits the claim and the resubmitted claim is received by the Program within the same period specified in §C of this regulation.