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I am using delay reason code 7 but claim denied due to timely filing in Medicaid. Can anyone guide me?

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Many people on the forum have relied on professionals to help them with the medicaid application process, the social worker at a facility or an elder law/medicaid attorney. If the alternative is being denied then I think that it is money well spent.
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Reply to cwillie
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Have you tried looking for a helpline number on your area's Medicaid website? If you can speak to a human being, I've always found that's the quickest way to discover where you're going wrong when you're filling out a form. It's often the case that these things are simple - when you know how.

I feel for you and for all Americans trying to find their way through the Medicaid maze. I have been on this forum for, gosh, five years? and tried to educate myself about how it's all supposed to work, and I have to say that sometimes I wonder how anyone in the US ever does manage to sort out their healthcare.

Would you like to say what the background to your claim is? - just in case that might shed any light on what the problem might be.
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Reply to Countrymouse
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when i use delay reason 7 then message appear claim has been denied due to timely filing .now what should do
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Reply to brookadam
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Couldn't resist poking around about this. So:

Q: Code 7 is what, pray?

A: 7 Third Party Processing Delay - must be submitted within 30 days from the time submission came within the control of the Provider.


From this I infer that the OP explained to Medicaid that the delay in submitting the claim happened because somebody else - hospital, service provider or whatever - dillied about instead of sending their payment demand over promptly. Or because some other crucial information was missing and had to be dug up from a basement in Kalamazoo. Whatever.

For this to be a valid and acceptable explanation, the claimant would have to have submitted the delayed claim within thirty days of having the 'submission' under his control.

But suppose you, an innocent family member, find out that your Aunty Flo has been in rehab for weeks, go to see her out of the kindness of your heart, and when you get there find she's in a complete muddle about what's going on and promise to go to her house. And suppose that at her house you find a reminder about an outstanding bill from the hospital, but you can't find the original and Aunty hasn't a clue, and you very kindly offer to assist her. It then takes you six weeks to track down copies of original documents. So the claim is older than ninety days, and it's taken you more than thirty days to solve it even once you became aware of it; but there are good reasons for that.

So the thing to have done, then, would have been to contact Medicaid about the potential claim immediately but explain that the claim could not be submitted until you obtained the documents and ask for an extension. If you waited until you got everything together... you've missed your four week deadline.

Or it could just be that the form is ambiguous about what date exactly they're asking about in what particular box, and it'll be a comparatively simple correction rather than any high-agility arguing that you'll need to do.

But in any case - I should ring them up and ask them. Could you by any human effort have got the claim into them within thirty days of having taken charge of it? Did you in fact meet that deadline? Keep arguing, and good luck!
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Reply to Countrymouse
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Not sure if I can help. Have filed for Medicaid for my Mom to cover her care in a NH. Have a disabled nephew that I handle his Medicaid for health insurance only.

What is reason code 7 and what are u filing for LTC or Medicaid health insurance?
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Reply to JoAnn29
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Brookadam, I'm up and about is the only reason I'm responding - unfortunately I'm in the UK and therefore haven't a clue, but don't go away! - there will be replies from people with very good Medicaid knowledge who can help.
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Reply to Countrymouse
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brookadam Nov 22, 2018
thank you for yours cooperation countrymouse
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