Provider Appeals — State Exceptions to Timely Dispute Filing Rule
In the absence of an exception below, Aetna's 180 day dispute filing standard will apply.
 |
 |
State |
 |
Abbrv. |
 |
Exception Applies To |
 |
Time Allowed to File an Initial Claim Payment Dispute |
 |
 |
 |
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 day |
 |
 |
 |
Colorado |
 |
CO |
 |
All providers -- 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 day |
 |
 |
 |
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)
|
 |
 |
 |
 |
State |
 |
Abbrv. |
 |
Exception Applies To |
 |
Time Allowed to File & Pursue a Dispute |
 |
 |
 |
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)
|
 |
 |
|