Each insurance carrier has guidelines for filing claims in a timely fashion. Some are as short as 30 days and some can be as long as 2 years. It is important to follow these guidelines or your claims may be denied for timely filing. Claims are often denied for timely filing when the claim actually was submitted in a timely fashion but not received by the insurance carrier. There are many reasons this can happen but the important part is how the biller responds to the denial. Sometimes claims are denied for timely filing when they were not filed within the timely filing period. This can be a problem.
Often claims are initially submitted with incorrect information. It may be 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 billing it 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. 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. Some carriers have special forms you must use, others don’t. If they do have a special form you should use it. Most likely they won’t accept the appeal if it’s not on their form. Usually the form will have a place to check off or write in the reason for the appeal. You should check off ‘timely filing’ or write in ‘denied for timely filing’. On one particular one we use we have to check ‘denied for incorrect reason’ and hand write ‘timely filing’ on the blank line. In any case you want to make sure you indicate you are appealing a timely filing denial.
If there is no form you could have a generic form that you use that just states ‘Claim denied for timely filing. Claim was originally submitted in a timely fashion. Proof attached.’ Whether you are using their form, or making your own, you should attach a copy of the claim, and your proof that you had filed it timely to that form. The proof needs to be something that shows when the claim was originally submitted and or when and how many times it was resubmitted.
If the claim was submitted electronically then you should have an electronic report showing the original submission. If the claim was denied electronically you may even have that electronic denial so that you can show what information was incorrect and that the claim was corrected and resubmitted.
If the claim was submitted on paper, your practice management system should provide you with some report showing the original submission date, and if the claim was submitted multiple times it should show each time submitted. Our system provides a patient ledger which shows the original date billed, the most recent date billed and how many times the claim was submitted in total. It must be something that was generated. It cannot just be a handwritten note stating ‘we submitted the claim on 1/1/2011.’
Reports generated from practice management systems generally cannot be altered and are accepted as proof by most insurance carriers. Some will state that if submitted on paper they must have proof from the post office that the claim was mailed. This is impossible for us and most. We mail so many items from our office it would be impossible to get proof on every item and then find a way to file that proof so that we could locate it if needed. There are very few carriers that will tell you this, but they are out there. The only way around this was if the claim was submitted electronically. They will accept clearinghouse reports as proof.
If your claim was denied for timely filing and it was not ever submitted in the time frame allowed then it is more difficult to appeal. If you have a valid reason for not submitting the claim then 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 could try to appeal. 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. You’ve got a 50/50 chance, but it’s worth appealing.
Basically, if you feel that you have an explainable valid reason that the claim was not submitted in time, you can submit an appeal. If there was any way that the claim could have been submitted in the time frame, it will most likely be denied. But if you have a valid reason, it will most likely be overturned and allowed. 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.