QUEST Integration – Claims Filing Deadlines

Original Effective Date:

08/01/1994

Current Effective Date:

05/18/2018

Claims

Participating QUEST Integration providers have one year from the date of service or discharge, whichever is the latter, to file all claims (e.g., initial submissions, resubmissions, adjusted submissions) to HMSA. When Medicare or any other Third Party Liability (TPL) are primary, providers must submit claims within six months from the date listed on the Explanation of Benefits (EOB) or twelve months from the date of service, whichever is greater.

Requests for Waiver of the Filing Deadline

When claims or adjustments are submitted outside the filing deadline period, providers must obtain a waiver of the filing deadline in order for the claim or adjustment to be considered for processing. Claims that have not been approved for waiver are rejected “RECEIVED AFTER FILING DEADLINE”.

To request a waiver, submit a written request with a copy of the late claim(s) or adjustment(s). Cases involving delayed processing of claims by the patient’s primary insurance, or involving unresolved eligibility issues will be considered, but are not guaranteed a waiver of the filing deadline.The request must provide the reason for the late filing, including a detailed history of the events that led to late filing and a record of the activities that trace your efforts to resolve the claim. Documentation may include dates that the primary insurance was billed, copies of any written communication between your office, the patient, other insurance or Med-QUEST.

Send requests to Provider Operations at:

HMSA Provider Operations

Attn: Research & Correspondence

P.O. Box 860

Honolulu, HI  96808-0860

Do not send waiver requests to Med-QUEST or include QUEST Integration claims with Medicaid claims submitted to Med-QUEST for waiver of the Medicaid filing deadline. Doing so delays the review determination as the claims must be rerouted to the correct office. Do not include an Appeal form either as your request may be routed to the Appeals team and further delayed.

You will be notified of the determination and the claim(s) or adjustment(s) attached to the request will be processed if the waiver is approved.

Deadline for Waiver Requests

Requests for waivers must be submitted no later than 120 days after the filing deadline.

Revision History