Everything You Need to Know About Timely Filing (Including a List of Timely Filing Limits!)
Timely filing and the timely filing limits that the insurance companies have in place is a top priority to know and to track in your private practice. If you don’t know or understand timely filing then you are in the right place. In this blog we are going to walk you through not only how to find timely filing with insurance along with a table of popular timely filing limits, but we are also going to give you a simple guide about timely filing and the systems that you can use to stay within those timely filing limits.
What is Timely Filing
Timely filing is the amount of time that a provider has to submit a claim to the insurance company to ensure that the insurance company will pay the claim. If the provider does not submit the claims to the insurance company within timely filing limits the insurance company will deny the claim and the provider will not be paid for those services.
Timely filing is also the amount of time that a provider has to submit an appeal on any denial that was received. For some insurance companies you have to keep in mind that the timely filing limit for the initial service and the timely filing limit for an appeal may actually be different. If you are receiving a lot of denials this is something that will need to be addressed quickly in order to see if you have an opportunity for payment.
For example, let’s say you have a client that has BCBS and you are in-network with BCBS. BCBS has a 365 day timely filing limit. That means that you have 365 days to submit the claims for your client to BCBS and are eligible for processing.
So, if you have a session with your client today and you submit the claim today then you would be within the timely filing limits, but if you were to see the client today and submit the claim 366 days from now the insurance company would deny the claim for being outside the timely filing limits.
Why is Timely Filing Important to Know and Track
Timely filing is important to know and track so that you can generate revenue from the claims that you submitted. You may think that waiting a year to submit claims is beyond what is logical but it happens all the time. The other part of timely filing that makes timely filing with insurance important to track is that not all insurance companies have the same timely filing periods, some are shorter and some are longer.
If you don’t know the timely filing limits of the insurances that you work with then you are setting yourself up for disappointment and a lot of denials.
The other reason why knowing the timely filing limits is important is because the denials for timely filing are final and cannot be appealed. In some ways, that policy makes sense. If the insurance company gave you a year to submit claims for services rendered but you did not get around to it, the insurance company shouldn’t be on the hook for those claims indefinitely. They have to set parameters around what they are responsible for and what they are not responsible for.
Knowing the timely filing limits helps you to keep your revenue stable throughout your time in taking insurance and lowers the amounts of denials that you receive from the insurance company. Even if you or your biller receive a timely filing denial there is no chance of appealing that claim and receiving payment.
How to Find Timely Filing Limits With Insurance
There are many ways to find the timely filing limits with insurance. The first way to find the timely filing limits with insurance is to search for it within that insurance company’s website. It might take you some time to find the timely filing limit but it will be located somewhere on the website.
The next way to find the timely filing limits with specific insurance companies is to search in the provider manual for that particular insurance company. Provider manuals are easier to locate within the website of the insurance company but that document tends to be quite large. You may have to search the provider manual for some time before you find the answer that you are looking for.
We generally recommend that you read the provider manual for each insurance that you are in-network with because there is helpful information included within those manuals that will help you interact with the insurance company, and this is one area where that piece of advice is particularly relevant.
The last way to find timely filing limits with insurance is to check back here at the Practice Solutions website frequently. We will be launching a resources page soon with a table of timely filing limits that will be continually updated.
For now, here is a table with many popular insurance company’s timely filing limits:
Insurance Company | Timely Filing Limit (From the date of service) | Source |
Aetna | 120 Days, but can vary by state | |
Aetna Better Health | 180 Days | |
Aetna Better Health Kids | 180 Days | |
Ambetter | 180 Days | |
AvMed | 1 Year | |
BCBS Florida | 1 Year | |
BCBS North Carolina | 18 Months | |
BCBS Rhode Island | 180 Days | |
BCBS Michigan | 180 Days 1 Year for BCBS Complete Plans | |
Anthem California | 90 Days | https://www.cmadocs.org/newsroom/news/view/ArticleId/28123/Anthem-Blue-Cross-to-reduce-timely-filing-requirement-to-90-days |
BCBS Illinois | 180 Days | https://www.bcbsil.com/pdf/standards/manual/billing_and_reimbursement.pdf |
Beacon Health | 90 Days | https://www.beaconhealthoptions.com/wp-content/uploads/Beacon-Provider-Handbook.pdf |
Blue Cross of California | 180 Days | https://providers.anthem.com/docs/gpp/california-provider/CA_MMP_RP_claims_timely_filing.pdf?v=202012282144#:~:text=Medi%2DCal%20Managed%20Care%20follows,and%20nonparticipating%20providers%20and%20facilities. |
Buckeye/Centene | 1 Year | https://ediacademy.com/blog/clean-claims-rejections/#:~:text=Participating%20providers%20must%20submit%20first,be%20denied%20for%20untimely%20submission. |
BCBS Alaska | 1 Year | https://www.premera.com/ak/provider/reference/medical-manuals/claim-submission-payments/ |
BCBS Arizona | 1 Year | https://www.azblue.com/healthcareprofessionals/resource-center/appeals-and-grievances |
Highmark BCBS Delaware | 120 Days | |
BCBS Mississippi | December 31 of the calendar year following the year in which the service was rendered | |
Highmark BCBS Pennsylvania and West Virginia | 1 Year | |
Carefirst Washington DC | 1 Year | |
Florida Blue | 1 Year | |
BCBS Hawaii | 1 Year | |
BCBS Louisiana | 15 Months | |
Anthem BCBS Ohio, Kentucky, Indiana, Wisconsin | 90 Days | |
Wellmark BCBS Iowa and South Dakota | 180 Days | |
BCBS Alabama | 2 Years | |
BCBS Arkansas | 180 Days | |
BCBS Idaho | 180 Days | |
BCBS Kansas | 12 Months | |
Blue Cross Massachusetts HMO, PPO Medicare Advantage Plans | 90 Days | |
Blue Cross Massachusetts Indemnity | 1 Year | |
BCBS Minnesota | 180 Days |
BCBS Montana | 180 Days | |
Horizon BCBS New Jersey | 180 Days | |
BCBS New Mexico | 180 Days | |
BCBS New York | 1 Year | |
BCBS of Northeastern New York | 1 Year | |
BCBS Oklahoma | 180 Days | |
BCBS Nebraska | Check with each individual plan as they are all different | |
Independence Blue Cross | 120 Days | |
BCBS Tennessee | 120 Days | |
BCBS Texas | 95 Days | |
BCBS Vermont | 180 Days | |
BCBS Wyoming | 60 Days | |
Caresource | 90 Days | |
Cenpatico | 90 Days | |
Champus | 1 Year | |
Cigna | 90 Days | |
Cigna (Out of network) | 180 Days | |
Emblem Health | 120 Days | |
Fidelis New York | 90 Days | |
GEHA | 90 Days | |
Harvard Pilgrim Health Care | 90 Days | |
Humana | 90 Days | |
Kaiser Permanente | 30 Days | |
Magellan | 60 Days | |
McLaren Health Plan | 1 Year | |
Medical Mutual | 1 Year | |
Medicare | 1 Year | |
Medicaid | 180 Days | |
Meridian | 1 Year | |
United Healthcare | 90 Days |
Systems to Use to Stay Within Timely Filing
If you are new to private practice you may be wondering how someone does not stay within their timely filing limit. The answer is that the life of an entrepreneur is complicated and can sometimes be distracted by all the tasks to do in a day. That is why it is important to have a system in place to make sure that all of the claims that you ought to be billing for are actually being billed.
The first step in the system of billing within the timely filing of insurance is to make sure you know your EHR. Some EHRs require that you complete your progress note or any other relevant documentation in order to submit a claim. If you don’t know that information definitively then you need to stop what you are doing and make sure that you are not sitting with a lot of unbilled claims.
If you are aware of that information we are happy to hear that! The trick is to set aside enough time to finish your progress notes so that claims can be generated and sent to the insurance company. Actually submitting claims to the insurance company is functionally easy, but did you know that sometimes a client’s eligibility can change? This means that while you think you are going to submit a clean claim you could not be. This is why we recommend that you check the client’s eligibility and benefits before submitting a claim.
Once you know that your client is eligible for payment, your notes and documentation is completed, and a clean claim has been created, then feel free to submit the claim to insurance and wait for a response from the insurance company. There is a lot of administrative work that is invested in ensuring claims process for payment, but we are confident that it can be done.
Conclusion
There are a lot of rules and regulations to follow when submitting claims to the insurance company. We want to be your trusted resource for medical billing and collections. We are excited at the prospect of working alongside you to free up your time and make sure that you are able to do what you want to do, and not get bogged down by the reality of third-party insurance. We are here to manage the medical billing and collections of your practice. Reach out and let us know how we can help you achieve your goals in private practice.
