Guidelines for Determining Coverage | Clinical Policy Bulletins | Medicare | Payment Policy | Dispute Process
Medical - State Exceptions to Timely Dispute Filing Rule
In the absence of an exception below, Aetna's 180 day dispute filing standard will apply.
| Arizona |
AZ |
All providers -- participating and nonparticipating |
1 year |
| California HMO |
CA |
All providers -- participating and nonparticipating, when the request relates to an
HMO member and the date of service is on/after 1-1-04 |
365 days |
| Colorado |
CO |
All providers -- participating and nonparticipating |
12 months |
| Florida |
FL |
All Practitioners -- participating and nonparticipating |
12 months |
| Georgia |
GA |
All providers -- participating and nonparticipating |
12 months |
| Indiana |
IN |
All providers -- participating and nonparticipating, effective with claims paid on
or after 7/1/06 |
2 years (from claim payment date) |
| Iowa |
IA |
All providers -- participating and nonparticipating |
2 years |
| Kentucky |
KY |
participating providers Only |
2 years |
| Maryland |
MD |
All providers -- participating and nonparticipating |
365 days |
| New Jersey |
NJ |
All providers -- applies to post service claims appeals submitted by participating
and nonparticipating licensed providers using the state prescribed Health Care Provider Application to Appeal a Claims
Determination |
18 months from the date of the first payment on a claim |
| North Carolina |
NC |
All providers -- participating and nonparticipating |
2 years from the original claim payment |
| Ohio |
OH |
All providers -- participating and nonparticipating |
2 years |
| Oklahoma |
OK |
All providers -- participating and nonparticipating |
2 years |
| Rhode Island |
RI |
All providers -- participating and nonparticipating |
2 years |
| Tennessee |
TN |
All providers -- participating and nonparticipating |
18 months |
| Washington |
WA |
All Listed providers -- participating and nonparticipating, effective 1/1/06 |
24 months (or 30 months for COB issues)
|
| Texas |
TX |
All participating providers and nonparticipating providers who are paid on a
participating basis (examples include an emergency situation, a network inadequacy issue, a nonparticipating provider who is
pre-approved by Aetna or a hospital-based physician who is a nonparticipating provider but provides services at a
participating facility) |
4 years for claims and non-claims issues -- (complaints are handled as appeals in
TX)
|