One major problem medical biller’s encounter is when claims are denied for timely filing because each insurance carrier has its own guidelines for filing claims in a timely fashion
It’s set by each individual insurance company to which you send claims. This means that if insurance company says that that their timely filing denial limits is 90 days, you have to make sure that you send all of your claims to them within 90 days of the date of service.
For example: If the patient was seen on January 1st, then you have to send the claim to the insurance company within 90 days of January 1st (before the end of March).
What happens if you don’t send claims out within the timely filing limit?
They get denied.
Unfortunately, if you don’t get your claims to the insurance company within the specified timely filing limit, they will be denied there isn’t anything you can do about it!
Other times, claims are denied for timely filing when they were not filed within the timely filing period due to initial mistakes.
It’s time to check why your claim gets denied!!
- Reasons for Claim Denials
- Only one reason for a denial is when a claim is initially submittedwith incorrect information.
- It may be a variety of things such as a typo on the part of the biller, it may be that the patient offered the wrong insurance card at the medical office, or it may be that when the information was transferred from the person who took the info to the person who is doing the medical billing and codingit wasn’t copied correctly.
- Lots of things can go wrong. At any rate, it doesn’t necessarily mean you won’t get paid for the services denied for timely filing, but you do need to know how to handle them.
- Handling Timely Filing Denials
- It is best to work out a system for handling claim denials for timely filing and just follow that system every time you encounter this problem.
- For example, you may have submitted a claim in the proper time frame and it was denied for a reason such as incorrect ID#, patient’s name was misspelled, or it was originally sent to the wrong insurance carrier.
- Now, you have fixed the problem and resubmitted it with the correct info, but the carrier denies it for timely filing. The denial must be appealed.
- Proof of timely filing denials
- The proof needs to be something that shows when the claim was originally submitted or when and how many times it was resubmitted.
- Some carriers have special forms you must use, others don’t. Whether you are using their form, or making your own, you should attach a copy of the claim, and your proof of timely filing to that form.
- Appealing Timely Filing Denials
- If your claim was denied for timely filing, and it was not ever submitted in the timeframe allowed, then it is more difficult to appeal. If you have a valid reason for not submitting the claim, you can appeal based on that.
- For example, if the patient stated that they didn’t have insurance because they thought that they were not covered at that time but then found out later that they actually were covered, and the claim is then submitted but after the filing deadline, you can try to appeal.
Conclusion
“It is important to file claims as quickly and timely as possible. But there are always things that come up that cause delays and timely filing denials do happen. If you have good systems in place, you will be able to appeal them quickly and efficiently and most will eventually get paid.
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