Kaiser Permanente timely filing limit

The windows

Your participation agreement can set a different window. Where the contract and the manual disagree, the contract applies.

Exceptions the payer allows

What counts as proof of timely filing

• The 277CA acknowledgement KP sends through your clearinghouse for each EDI claim, showing whether it was accepted or rejected
• KP's acknowledgement of a paper claim, which the claims settlement notice says is sent within 15 working days of receipt
• For a secondary claim, the primary carrier's EOB, whose date starts the 90-day COB window
• For a late claim, a Provider Dispute Notice that documents good cause for the delay

Notes for billers

• KP's manual and claims settlement notice do not list documents accepted as proof of timely filing. Providers are responsible for reviewing their clearinghouse acknowledgement reports, so keep the 277CA for every claim and resubmit rejected ones electronically.
• Other KP regions run different clocks. A corrected claim for missing information is due within 90 calendar days in Colorado and 365 calendar days in Georgia, Hawaii, the Mid-Atlantic States and the Northwest, and outside California COB information is due within 12 months of the request for commercial claims or 24 months for Medicare and Medicaid.
• A dispute missing required information is returned. Send the amended dispute within 30 business days of KP's notice, and never later than 365 calendar days from KP's last action. KP acknowledges disputes within 15 business days on paper or 2 business days online and sends a determination within 45 business days.
• Send a replacement claim only after the original is paid, denied or otherwise finalized, with the original claim number from the 835 or the EOP. A replacement without a valid original claim number is rejected.
• Balance billing KP members for covered services is prohibited by state and federal law and by your agreement. Members owe only their copayments, coinsurance and deductibles.