medicare timely filing limit for corrected claims

medicare timely filing limit for corrected claims

For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. When correcting or submitting late charges on a 1500 professional claim, use the following frequency code in Box 22 and use left justified to enter the code. 3 0 obj The Patient Protection and Affordable Care Act (PPACA) signed into law on March 23, 2010, by President Obama included a provision which amended the time period for filing Medicare Fee-For-Service (FFS) claims. Example: A claim has a From date of 7/1/2015 and a Through date of 7/31/2015. These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright 2002, 2004 American Dental Association (ADA). THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. Therefore, only those appeal requests . Please click here to see all U.S. Government Rights Provisions. The scope of this license is determined by the ADA, the copyright holder. For more details, go to, If you received a letter asking for additional information, submit it using Claims in the. The scope of this license is determined by the AMA, the copyright holder. CMS DISCLAIMER. Please keep the following in mind when submitting paper Claims: - Paper Claims should be submitted on original red colored CMS 1500 Claims forms. Note: Each provider request for exception will be evaluated individually based on the evidence submitted with the request. %%EOF If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". + | U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. CMS Disclaimer License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Remember: Your contract with Cigna prohibits balance billing your patient if claims are denied because they were not submitted within the time frame outlined above. By continuing beyond this notice, users consent to being monitored, recorded, and audited by company personnel. . All Rights Reserved (or such other date of publication of CPT). Therefore, it is important to ensure that your billing transactions are corrected from RTP (T B9997) status/location prior to the timely filing deadline. End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. If a beneficiary indicates another insurer is primary over Medicare, bill the primary insurer prior to submitting a claim to Medicare. The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. Paper claims should be mailed to: Priority Health Claims, P.O. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. CPT is a trademark of the AMA. click here to see all U.S. Government Rights Provisions, Medicare Claims Processing Manual, (Pub. Medicare claims must be filed to the MAC no later than 12 months, or 1 calendar year, from the date the services were furnished. Before you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. The conditions for meeting each exception, and a description of how filing extensions will be calculated, are described in sections 70.7.1 70.7.4. click here to see all U.S. Government Rights Provisions, Untimely Filing section on the Reopenings, Medicare Claims Processing Manual, CMS Pub. SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. The AMA does not directly or indirectly practice medicine or dispense medical services. The scope of this license is determined by the AMA, the copyright holder. Email us at You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. The scope of this license is determined by the ADA, the copyright holder. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB). A claim that is denied because it was not filed timely is not afforded appeal rights. End Users do not act for or on behalf of the CMS. @H3"@ R_ All rights reserved. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. As always, you can appeal denied claims if you feel an appeal is warranted. Applications are available at the American Dental Association web site, http://www.ADA.org. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS). , Medicare Claims Processing Manual, Pub. Error or misrepresentation by an employee, Medicare contractor, or agent of the Department of Health and Human Services (HHS) that was performing Medicare functions and acting within the scope of its authority. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. 240 - Time Limits for Filing Appeals & Good Cause for Extension of the Time Limit for Filing Appeals 240.1 - Good Cause 240.2 - Conditions and Examples That May Establish Good Cause for Late Filing by Beneficiaries . Superior must receive all: Outpatient (office, facility, ancillary) provider claims within 95 days from each date of service on the claim. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA does not directly or indirectly practice medicine or dispense medical services. 1 0 obj This Agreement will terminate upon notice to you if you violate the terms of this Agreement. Refer to the Untimely Filing section on the Reopenings web page for additional information. The ADA does not directly or indirectly practice medicine or dispense dental services. All Rights Reserved (or such other date of publication of CPT). %PDF-1.5 % AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. The scope of this license is determined by the ADA, the copyright holder. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. hSoKaNv'[)m6[ZG v mtbx6,Z7Rc4D6Db%^/xy{~ d )AA27q1 CZqjf-U6._7z{/49(c9s/wI;JL4}kOw~C'eyo4, /k8r?ytVU kL b"o>T{-!EtZ[fj`Yd+-o3XtLc4yhM`X; hcFXCR Wi:P CWCyQ(y2ux5)F(9=s{[yx@|cEW!BFsr( This license will terminate upon notice to you if you violate the terms of this license. Therefore, you have no reasonable expectation of privacy. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. UnitedHealthcare has developed Medicare Advantage Policy Guidelines to assist us in administering health benefits. Retroactive Medicare entitlement to or before the date of the furnished service. The scope of this license is determined by the AMA, the copyright holder. . The "Through" date on claims will be used to determine the timely filing date. Medicare crossover claims for coinsurance and/or deductible must be filed with DOM within 180 days of the Medicare Paid Date. End users do not act for or on behalf of the CMS. endobj Pre-Service & Post-Service Appeals. 1, 70 specify the time limits for filing Part A and Part B fee-for- service claims. Warning: you are accessing an information system that may be a U.S. Government information system. ", Paper claims should include a copy of the letter that indicates the date range for the claims involved or the effective date of the Medicare entitlement. var url = document.URL; CMS DISCLAIMER. Medicare Claims Processing Manual Chapter 34 - Reopening and Revision of Claim . These include: If you are not currently registered for the Cigna for Health Care Providers website, go to CignaforHCP.com and click on the Login/Register link. Users must adhere to CMS Information Security Policies, Standards, and Procedures. If a claim isn't filed within this time limit, Medicare can't pay its share. These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright 2002, 2004 American Dental Association (ADA). Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen. hbbd``b`n3A+P L6 BD W| b``%0 " THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. Box 232, Grand Rapids, MI 49501. Details, Applicable law requires a longer filing period, Provider agreement specifically allows for additional time, In Coordination of Benefits situations, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefits (EOB) or explanation of payment (EOP). Adhering to this recommendation will help increase providers offices' cash flow. Applications are available at the, Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. The AMA is a third-party beneficiary to this license. If you choose not to accept the agreement, you will return to the Noridian Medicare home page. CPT is a trademark of the AMA. To submit a corrected claim to Medicare make the correction and resubmit as a regular claim (Claim Type is Default) and Medicare will process it. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. CDT is a trademark of the ADA. To license the electronic data file of UB-04 Data Specifications, contact AHA at (312) 893-6816. a listing of the legal entities Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen. 0 CDT is a trademark of the ADA. Inpatient hospital claims (including all interim bills) within 95 days from the date of discharge. Questions? CDT is a trademark of the ADA. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Note: Adjustment claims (Type of Bill ending in XX7) submitted by the provider are also subject to the one calendar year timely filing limitation. THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. Different payers will have different timely filing limits; some payers allow 90 days for a claim to be filed, while others will allow as much as a year. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. Frequency code 8 Void/Cancel of Prior Claim: Indicates this bill is an exact duplicate of an incorrect bill previously submitted. In addition, claims that have Returned to Provider (RTP'd) for corrections and resubmitted, are also subject to timely filing standards. B'z-G%reJ=x0 E The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Claims must be submitted by the last day of the sixth calendar month following notification that the error has been corrected by the government agency. Back to Top U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. To expedite billing and claims processing, claims must be sent to Kaiser Permanente within 30 days of providing the service. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. The "Through" date on a claim is used to determine the timely filing date. CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). An initial determination on a previously adjudicated claim may be reopened for any reason for one year from the date of that determination. Timely filing of claims AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. A Medicare Advantage (MA) plan or Program of All-inclusive Care for the Elderly (PACE) provider organization recoups money from a provider or supplier 6 months or more after the service was furnished to a beneficiary who was retroactively disenrolled to or before the date of the furnished service. Exceptions to the 1 calendar year time limit for filing Medicare home health and hospice billing transactions are as follows: Refer to the Medicare Claims Processing Manual, CMS Pub. The AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. 0 THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. The written request for exception for claim(s) sent to CGS must contain the following elements: Note:A written request for exception may take up to 45 business days for research and a response. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Navigation. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). When a Claim is Rejected A claim that is rejected for being filed after the timely filing period is not subject to a formal appeal (i.e., redetermination). This Agreement will terminate upon notice to you if you violate the terms of this Agreement. Applications are available at the AMA Web site, https://www.ama-assn.org. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. The ADA does not directly or indirectly practice medicine or dispense dental services. 100-04, Ch. The filing limit for claims where ConnectiCare is secondary is 180 days after the issue date of the last claim summary or EOB received from the primary carrier. All rights reserved. This license will terminate upon notice to you if you violate the terms of this license. This code will void the original submitted claims. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. VHA Office of Integrated Veteran Care. In general, Medicare does not consider a situation where (a) Medicare processed a claim in accordance with the information on the claim form and consistent with the information in the Medicare's systems of records and; (b) a third party mistakenly paid primary when it alleges that Medicare should have been primary to constitute "good cause" to reopen. 100-04, Ch. However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN. On January 21, 2011, the Centers for Medicare & Medicaid Services (CMS) announced four exceptions to the 12 month Medicare claim filing period. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). Corrected Facility Claims 1. Submit a new CMS 1500 or UB-04 CMS-1450 indicating the correction made. 100-04), chapter 1, section 70.7, 26 Century Blvd Ste ST610, Nashville, TN 37214-3685. The ADA is a third-party beneficiary to this Agreement. For example, a claim with dates of service 9/15/2015, must be received by 9/15/2016 for processing. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. What is MagnaCare timely filing limit? The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. This provision was aimed at curbing fraud, waste, and abuse in the Medicare program. Medicare Advantage: Claims must be submitted within one year from the date of service or as stipulated in the provider agreement. A claim that is rejected for being filed after the timely filing period is not subject to a formal appeal (i.e., redetermination). Email | 180 DAYS FROM DOD. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. %%EOF 8J g[ I Timely Claim Filing: The receipt of a clean claim must be within the timeframe applicable to the claim type. Time limits for filing claims You are required to submit to clean claims for reimbursement no later than 1) 90 days from the date of service, or 2) the time specified in your Agreement, or 3) the time frame specified in the state guidelines, whichever is greatest. Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided. This license will terminate upon notice to you if you violate the terms of this license. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. End users do not act for or on behalf of the CMS. End Users do not act for or on behalf of the CMS. 1, 70. % When a claim denies because it was received after the timely filing period, such denial does not constitute an "initial determination" and, therefore, is. CPT is a trademark of the AMA. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. Medicare (Cigna for Seniors): In accordance with Medicare processing rules, non-participating health care providers have 15 to 27 months to file a new claim. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. Frequency code 7 Replacement of Prior Claim: Corrects a previously submitted claim. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. For example, if the "From" date of service is 7.1.2021 and the "Through" date of service is 7.31.2021, the claim must be received by 7.31.2022. This will allow you to adjust the MSP claim if the primary insurer later recoups their money. No fee schedules, basic unit, relative values or related listings are included in CPT. View details. LICENSE FOR USE OF "PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY", (CPT) MSP and tertiary payer situations do not change or extend Medicare's timely filing requirements. 5066 0 obj <>stream Bookmark | hb```w,,(PQAAYNV)t[R36.y~n[~;={!mh```l`hhh0 4@$kDECXHkc` California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. All Rights Reserved. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. Error or misrepresentation of an employee, the Medicare Contractor or agent of the Department of Health and Human Services (DHHS) that was performing Medicare functions and acting within the scope of its authority, Medicare will extend the timely filing limit through the last day of the sixth month following the month in which the beneficiary, provider or supplier received notice that an error or misrepresentation was corrected, Beneficiary receives notification of Medicare entitlement retroactive to or before the date the service was furnished, Medicare will extend the timely filing limit through the last day of the sixth month following the month in which the beneficiary, provider or supplier received notification of Medicare entitlement retroactive to or before the date of the furnished service, A state Medicaid agency recoups payment from a provider or supplier six months or more after the date the service was furnished to a dually eligible beneficiary, Medicare will extend the timely filing limit through the last day of the sixth month following the month in which a state Medicaid agency recovered Medicaid payment from a provider or supplier, A beneficiary was enrolled in an MA plan or PACE provider organization, but later was disenrolled from the MA plan or PACE provider organization retroactive to or before the date the service was furnished, and the MA plan or PACE provider organization recoups its payment from a provider or supplier six months or more after the date the service was furnished, In these cases, Medicare will extend the timely filing limit through the last day of the sixth month following the month in which the MA plan or PACE provider organization recovered its payment from a provider or supplier, Providers may contact the J15 Part A Provider Contact Center (PCC) by phone at, Please note Customer Service Representatives are unable to, The address on the company letterhead must match the 'Master Address' in the provider's Medicare enrollment record, The provider's six-digit Provider Transaction Access Number (PTAN), The provider's National Provider Identifier (NPI), The last five digits of the provider's Federal Tax Identification (ID) number, Dates of service for the claim(s) in question, A written report by the agency (Medicare, Social Security Administration (SSA), or Medicare Administrative Contractor (MAC)) based on agency records, describing how its error caused failure to file within the usual time limit, Copies of an agency (Medicare, SSA, or MAC) letter reflecting an error, A written statement of an agency (Medicare, SSA, or MAC) employee having personal knowledge of the error, CGS Claims Processing Issues Log (CPIL) showing the system error, Copies of a SSA letter reflecting retroactive Medicare entitlement, Dated screen prints of the Common Working File (CWF) showing no Medicare eligibility at the time the claim was originally submitted and dated screen prints of CWF showing the retroactive Medicare eligibility, Copy of a state Medicaid agency letter reflecting recoupment, Copies of an MA plan or PACE provider organization letter reflecting retroactive disenrollment, Dated screen prints of the CWF showing MA plan or PACE provider organization eligibility at the time the claim was originally submitted, Proof of MA plan or PACE provider organization recoupment of a claim.

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