Medicare Payment Floor
The Medicare Payment Floor refers to the amount of time Wisconsin Physicians Service (WPS) has to finalize and process claims. Based on how you file claims, your Provider Remittance Notice (PRN) and check(s), if appropriate, will be issued after the pertinent timeframes. The Medicare Claims Processing Internet-Only Manual Publication 100-4, Chapter 1, Section 80.2.1.2 instructs WPS not to " . . . pay, issue, mail, or otherwise pay for any claim it receives from providers within the waiting period as indicated below. The length of the waiting period is determined by the date a claim is received. The carrier [WPS] starts its count on the day after the day of receipt." Messages may appear on the remittance notice and the beneficiary Medicare Summary Notice (MSN) if the claims information has been forwarded to the beneficiary's supplemental insurer.
- HIPAA-compliant Electronic Claims: 13 calendar days from claim receipt date
- Non-HIPAA compliant Electronic Claims: 26 calendar days from claim receipt date*
- Paper Claims: 29 calendar days from claim receipt date (Per Change Request (CR) 4284, Click Here to read the CMS Medlearn Matters Article related to this CR.)
*Effective July 1, 2004, the Medicare contingency plan is being modified to encourage migration to HIPAA formats. Effective July 1, 2004, for purposes of the payment floor, only those claims submitted in a HIPAA-compliant format will be paid as early as the 14th day after the date of receipt. Claims submitted electronically under a pre-HIPAA format supported by Medicare under the contingency plan period, including the UB-92 flat file, the National Standard Format (NSF), a pre-version 4010A1 X12 837, or on paper after July 1, 2004 will not be eligible for payment earlier than the 27th day after the date of receipt. For more information on this change, please click here to see the full article.
Page Last Updated: Tuesday, 04-Dec-2007 13:19:17 CST
