08/18/2026

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August 2026 Frequently Asked Questions

Question:

What are the timely filing requirements for WPS?

Answer:

Timely Filing of Claims

Published on Feb 7, 2023, Last Updated Jul 27, 2026

Jurisdictions: J5A J5B J8A J8B

To be eligible for Medicare reimbursement, providers must file claims for services furnished on or after January 1, 2010, within one calendar year of the date of service.

Patient Responsibility on Claims Denied for Late Filing

The provider may collect 20% of what would have been the Medicare fee schedule allowed amount, when the claim denies for late filing. The patient is not responsible for the entire billed amount.

Claims Denied Based on the Timely Filing Limit Do Not Have Appeal Rights

CMS requires Medicare contractors to deny claims submitted after the timely filing limit. In addition, the CMS Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1 – General Billing Requirements, Section 70.4 states, "When a claim is denied for having been filed after the timely filing period, such denial does not constitute an “initial determination”. As such, the determination that a claim was not filed timely is not subject to appeal."

Denied Claim Not Filed Within the Time Limits due to Third Party Error

Providers often ask Medicare contractors to reopen claims denied for timely filing when another insurer recouping their previous payment caused the delay. CMS does not accept errors caused by incorrect third-party payment as justification for not submitting timely claims to Medicare. The CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34 – Reopening and Revision of Claim Determinations and Decisions, Section 10.11, states the following:

"Third party payer error in making a primary payment determination does not constitute good cause for the purposes of reopening an initial determination or redetermination when Medicare processed the claim in accordance with the information in its system of records or on the claim form. Contractors may only reopen for third party payer error under the “within one year for any reason” standard. This is true for both contractor initiated reopenings as well as reopenings requested by a party. All providers and suppliers have a legal obligation to determine the correct primary payer when billing Medicare. Failure to do so, regardless of third party payer error, does not constitute “good cause” that will permit reopening beyond one year. Information regarding such error does not constitute “new and material evidence.”"

Potential Reasons Medicare May Extend the Late Filing Limit

In rare cases, CMS permits Medicare contractors to extend the time limit for filing a claim beyond the usual deadline if the provider can show good cause for the delay in filing the claim. CMS indicates that Medicare contractors could determine good cause exists when an administrative error on the part of an official Medicare employee acting on behalf of the Medicare contractor within the scope of his/her authority caused the delay. Circumstances such as backdated Medicare entitlement may also qualify for an extension of the timely filing deadline. In such situations, providers must file the claim promptly after the error is corrected.

How to File a Waiver to Extend the Timely Filing Limit

Providers who believe they meet the qualifications for "good cause" must submit the following items to the WPS Government Services Claims Manager to request a waiver of timely filing:

• An original, paper (red and white) CMS-1500 claim form, plus any documentation needed to process the claim.

• Documentation proving you met "good cause" for late filing (e.g., a copy of the beneficiary's retroactive Medicare entitlement letter from the Social Security Administration).

• Request for Waiver to Extend the Timely Filing Limit

It is important that the request for a waiver of timely filing and documentation supporting the request accompany their claim. The Claims Manager will review the request to determine whether good cause exists, as defined by CMS. We will notify providers of the outcome of their request via their remittance notice when we process the claim. Providers should mail their claim, waiver request, and supporting documentation to the attention of the Claims Manager at the appropriate state specific address below.

Since claims denied for timely filing do not have appeal rights, the WPS Appeals area cannot grant any waiver to the timely filing deadline after we process the claim. Therefore, do not send your request to WPS using the Redetermination Request Form.

Indiana
WPS Government Services Part B
Indiana Claims Manager
PO Box 8940
Madison, WI 53708-8940

Michigan
WPS Government Services Part B
Michigan Claims Manager
PO Box 8987
Madison, WI 53708-8987

For more information about the requirements for extending the time limitation for filing a Medicare claim, please see the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 1 – General Billing Requirements, sections 70.7, 70.7.1 and 70.7.2.

Question:

Does Medicare charge interest on overpayments to Medicare Providers?

Answer:

Yes

Overpayment and Underpayment Interest Rates

Published on Jul 20, 2026

Jurisdictions: J5A J5B J8A J8B

Medicare Regulation 42 CFR Section 405.378 provides for the charging and payment of interest on overpayments to Medicare providers. CMS assesses interest on delinquent debts to protect the Medicare Trust Fund.

The Secretary of Treasury certifies an interest rate quarterly based on the most comprehensive data available on consumer interest rates. The following interest rates apply as indicated: