Timely Filing

You create a claim and mail it to the health carrier for processing and 90 days later, no payment, no denial, nothing. So you call the insurance carrier to check status and you learn that, for whatever reason, your claim was never received; they have no record of the claim.

So, you create another claim and mail it to the health carrier. Because the first claim went missing, you call the health carrier 14 days later and the health carrier confirms that, yes, they have the claim on file. You add this to the "win" category since payment is surely on the way. A few weeks later you receive a letter stating that the claim has been denied for timely filing.

You call the carrier and learn that this plan has a 60 day timely filing period. You have 60 days from the date the service was rendered to get that claim over to the health carrier. Your claim was initially billed well within that time frame but you have no proof that the claim was ever received by the carrier. No payment will be forthcoming on this claim.   

What is time filing?

Timely filing refers to the amount of time you have to get that claim over to the health carrier. Timely filing periods vary greatly. I have seen some as short as 30 days and some as long as 365 days. 365 days is average but more and more carriers are moving toward 180 days and shorter timely filing periods. This refers to mailed claims only since electronic claims will have an automatic time tracking. Claims received by the health carrier after the timely filing period will be denied as “too old” to process.

Example of timely filing:

Timely filing period: 60 days

Claim Date of service 1/1/16

Claim received: 3/10/16

Claim will be denied

If a claim is denied for time filing you really do not have much recourse. So, the plan is to be proactive not reactive, for example:

  • Find out the timely filing period from the health carrier’s website or from Customer Service when you call to verify benefits and eligibility.
  • Bill electronically, this way you have an automatic date stamp that shows when your claim was received by the health carrier. You can use this to dispute all timely filing denials.
  • Keep cheat sheets of all timely filing periods or, at the very least, the ones that have short filing periods.
  • Calendar to make sure that you call the health carrier to confirm that the claim has been received for all health plans that have a short timely filing period.   
  • Keep your eye on all secondary or tertiary claims, as the clock will start ticking from the date of the primary/secondary EOB, not the date you decide to bill the claim.
  • Timely filing periods also affect the time you have to dispute an incorrect claim payment.

Unless the patient is clearly at fault for failing to provide some necessary information that was needed to bill the claim, maybe the patient failed to provide a copy of the primary carrier’s EOB or an updated insurance ID card; you will have a hard time making the patient responsible for the balance that remains on account because the provider’s office failed to get the claim over to the carrier timely.

Most timely filing errors are usually written off as bad debt, meaning that the patient is not billed and the provider’s revenue will take a hit for any claims that cannot be reimbursed.

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