This performance measure is important because it tracks how long it takes the DVHA Reimbursement Unit to review and process timely filing requests from providers. The goal is to complete requests in a timely and consistent manner, as providers appreciate having a decision made sooner rather than later.

Medicaid has regulations on how long providers have to submit claims for reimbursement, this is called timely filling. For claims that were originally submitted in a timely manner but were denied payment, the DVHA Reimbursement Unit will review the supporting documentation and make a final decision on whether the claim should be paid.  Starting in 2021, the Timely Filing metric was expanded to include the tracking of Ad-hoc timely filing requests due to a persistent and significant increase in volume. Ad-hoc requests are bundled requests of 50 or more claims submitted by a provider requesting a timely filing override due to an issue the provider was experiencing, examples would be a provider implementing new software or claim reconciliations by other AHS departments such as DMH and DAIL.  

Factors that can affect the trendline are large increases in the volume of requests received and Reimbursement’s ability to apply increased resources to this task while still meeting conflicting work demands, deadlines, staff turnover and temporary reductions in staff.  During October 2022 the resources of the unit were focused on rate reviews and updates while also experiencing a temporary reduction in staff that affected the unit’s ability to meet its target. In November of 2022, the review completion rate jumped back up to 96.8% despite the # of ad-hoc requests increasing from 92 to 9,075 due to a timely filing override request from a provider as a result of the implementation of an Electronic Health Record system. The target for December was unattainable due to a temporary shortage in staff members and conflicting duties, including review and update of reimbursement rates and quarterly codes.

Narrative last updated:  02/16/23

• Medicaid Providers
• Gainwell Technologies
• Department of Mental Health
• Department of Aging & Independent Living
• Department for Children & Families