What is a Timely Filing Limit and How Can it be Contested?

What is a Timely Filing Limit and How Can it be Contested?

One of the most common issues medical billers face is claims being denied for timely filing because each insurance carrier has its own rules for reporting claims on time. A timely filing limit is a timeframe within which a claim must be submitted to a payer in medical billing. Many payers will have different time limits for filing claims. Even within the same insurance company, this time limit may fluctuate for different plans.

Payers determine their deadlines for timely filing based on the date of service. If a claim is received after the deadline, the carrier will deny it and the patient will not be held accountable.

Major payers and their timelines for filing

It is common for providers to submit claims outside of the timely filing limit without realizing it, and then receive a denial for those claims. Here are some of the most common payers and their timely filing deadlines.

  • Medicaid has a 95-day timely filing limit

  • Medicare has a 365-day timely filing limit

  • UnitedHealthcare has a 90-day timely filing limit

  • Cigna has a 90-day timely filing limit

  • BlueCross BlueShield generally has a 365-day timely filing limit

Reasons for Claim Denials

When a claim is initially submitted with erroneous information, it can result in a denial. It could be due to a biller’s mistake, the patient having issued the incorrect insurance card at the medical office, or the information not being copied correctly when it was given from the person who took the information to the person who is conducting the medical billing and coding. There are many things that can go wrong.

In any case, it doesn’t necessarily mean you won’t be paid for services that were refused due to late filing, but you should be prepared to deal with them. It’s best to devise a procedure for dealing with claim denials.

How denial for timely filing be contested?

When a claim is refused due to late filing, it does not necessarily mean that all other options have been exhausted. You should definitely appeal if you truly filed a claim within the time limits. In this situation, you’ll need to present confirmation that the claim was sent and received within the time limit. This can include EDI logs and insurance correspondence.

Explain why you didn’t file a claim in a timely manner if you didn’t. A thorough letter describing the situation is necessary at this point. When AMPM took over a new client’s Old AR, we successfully contested claims that were over three years old.

Acting promptly can be the difference between a paid claim and a write-off in any case. Create workflows with checks and balances to ensure all encounters on the schedule are billed out. Get your facts organized on a cheat sheet, verify insurance coverage to ensure you’re billing the claim to the correct primary carrier, and most importantly, create workflows with checks and balances to ensure all encounters on the schedule are billed out.

Basically, you can file an appeal if you believe you have a reasonable and valid reason why the claim was not submitted on time. If the claim could have been made within the timeframe, it will most likely be refused. However, if you have a good cause, it will almost certainly be reversed and you will be permitted to continue.

It is necessary to file claims as quickly and as soon as possible. However, things do arise that cause delays, and timely filing denials do happen. You will be able to appeal to them swiftly and efficiently if you have strong protocols in place, and the majority of them will eventually be paid.

It’s a good idea to make a spreadsheet with the filing restrictions for the insurances available in your state. It’s also worth noting that appeals for late filing denials have their own deadlines, which should be noted in your spreadsheet. Finally, check to see whether you have any inpatient care filing deadlines, as they can differ.

In short, Timely filing write-offs can be avoided, but it takes diligence on the side of billers and management to do so. Methods to reduce/eliminate promptly filing write-offs should be included in the physician billing process. Visibility, reporting, and supervision are all important for optimizing your team and maintaining the correct mix of quality and output.

Zee Medical billing can help you in successful billing.

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