Denial for Timely Filing

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.

Advertisements

10 Responses to “Denial for Timely Filing”

  1. Barbara Griswold, LMFT Says:

    I was recent denied by UBH due to timely filing when I actually had submitted the claim twice within the acceptable time period via my online clearinghouse (OfficeAlly.com), yet for some reason the plan did not show any record of receiving the claims. This was especially strange since they paid on all other claims for other plan clients submitted in the same batch. When I finally submitted by fax they were denied and I appealed, and provided proof from OfficeAlly of the filings (with date and time and initial acceptance), They denied my appeal, basically saying that my proof of clearinghouse submission was not enough, and that they could not be held accountable for clearinghouse electronic problems, and implying that it was still up to me to be responsible for making sure they received it in a timely manner.

    Word to the wise — follow up!
    Barbara Griswold
    Author, Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance — And Whether You Should
    http://www.theinsurancemaze.com
    barbgris@aol.com

    • solutionsmedicalbilling Says:

      We have run into some insurance carriers that do not accept our proof and uphold the denial. It isn’t very common but it does show how important timely follow up is! We had a company start denying all timely filing appeals but we appealed to the next level stating that our proof should be sufficient and we actually won! Now they accept our clearing house reports and patient ledgers as proof. They are our largest payor locally so this was a big win.

      http://www.solutions-medical-billing.com
      http://www.medicalbillinglive.com

      • Jose Says:

        I am also having issue’s on Medical group paying even if I have the proof that it was submitted on time with the Office Alley Timely. I have submitted letters to the Medical Group that they can not deny the claim only if they thought that it is to be considered fraud on our part and they still deny our claim for timely. When you have thousanda of claim to follow up it is pretty hard to keep track of all of them especialy when the same Medical Group pays for some of our claims like a Year to two years later. when we think that the claim is in process and then we check for claims being denied then we realize that they are not paying. How can you write a good solid appeal letter for something like this?

      • solutionsmedicalbilling Says:

        Well, I always make sure I send a cover letter which states we are appealing the denial, that the claim was originally submitted timely, and what proof I’m attaching. If submitted thru Office Ally I include the report from Office Ally showing the claim accepted by the insurance carrier if possible. Plus I include our internal proof which is a printed out patient ledger showing the dates the claim was submitted and how many times. We have very good luck with this. There are just a few companies out there who do not accept this as proof.

        Solutions Medical Billing
        Medical Billing Live

      • Jose Says:

        I have done all of the above and they still deny to pay the claims. Sometimes I do get lucky but sometimes not so lucky. Is there any law that they cant pay after a certain time period even after provideing them with proof of timely from office alley? I dont see why the insurance dont pay when they have the Health plan paying them. I htink this year has been really tough on insurance payers.

      • barbgris Says:

        I had this issue with UBH — I submitted proof of timely filing via Office Ally in my appeal, they denied it, basically saying they wouldn’t be held accountable for problems with OA. I filed a complaint with the CA Dep of Managed Care, and lo and behold, a check from UBH arrived a few weeks later. Don’t forget sometimes this is a useful avenue —
        Barbara Griswold, MFT,
        Author, Navigating the Insurance Maze
        http://www.theinsurancemaze.com
        barbgris@aol.com

  2. Abi Says:

    Found the solution to get payment for my claim which was denied as untimely filing:-)

  3. Jose Says:

    I have wanted to do that plenty of times because they have been some issue where they are wrong and I have been wanted to compaint to the Dpt of Managed Care but my company wont allow. They think that we might loose business I guess.

  4. Sue Says:

    Our practice uses an outside billing source and we have several claims that were denied over the years due to untimely filing, they claim to have appealed the denial with the appeals were overturned and the denials of health. Now our billing company is asking us to refund the co-pay collected from the patients for these dates of service. It makes no sense as we did the work and collected the co-pay in good faith. Can we keep the co-pay if a claim is denied due to untimely filing?

    • solutionsmedicalbilling Says:

      Unfortunately you are supposed to return the co-pays when the claims are denied. Not sure why they are having a problem with getting the claims paid timely. As long as they were filed in a timely fashion an appeal should overturn the denial.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s