Timely filing denials are often upheld due to incomplete or invalid documentation submitted with reconsideration requests. If you have good systems in place, you will be able to appeal them quickly and efficiently and most will eventually get paid. But there are always things that come up that cause delays and timely filing denials do happen. It is important to file claims as quickly and timely as possible. But if you have a valid reason, it will most likely be overturned and allowed. If there was any way that the claim could have been submitted in the timeframe, it will most likely be denied. Basically, if you feel that you have an explainable and valid reason that the claim was not submitted in time, you can submit an appeal. You’ve got a 50/50 chance, but it’s worth appealing. Write up a letter explaining exactly what happened, why the patient didn’t think they were covered, and what made them realize that they were. 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. If you have a valid reason for not submitting the claim, you can appeal based on that. 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. 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 coding it wasn’t copied correctly. The reason for a denial is when a claim is initially submitted with incorrect information. Other times, claims are denied for timely filing when they were not filed within the timely filing period due to initial mistakes. There are many reasons this can happen, but the important part of the equation is how the biller responds to the denial. It is important to follow these guidelines or your claims may be denied for timely filing.Ĭlaims are often denied for timely filing when the claim was actually submitted in a timely fashion but not received by the insurance carrier. Some are as short as 30 days and some can be as long as two years. Each insurance carrier has its own guidelines for filing claims in a timely fashion. The time limit is calculated from the date service provided. Insurance will deny the claim with denial code CO 29 – the time limit for filing has expired, whenever the claims submitted after the time frame.
0 Comments
Leave a Reply. |