Timely Filing and How You Can Crush It
Main Points
Timely filing is when an insurance company put a time limit on claim submission
Know your timely filing limits
Processes for dealing with timely filing denials
Timely filing denials are some of the most common denials that you will experience in private practice. If you are already in private practice you have likely had several claims deny due to timely filing requirements.
But there is a little bit ambiguity around timely filing especially around when a provider can challenge a timely filing denial.
Timely filing is when an insurance company put a time limit on claim submission. For example, if a insurance company has a 90-day timely filing limit that means you need to submit a claim within 90 days of the date of service. The challenge is knowing what the timely filing limit is for the insurance company that you are submitting claims for.
There is no standardized timely filing limit so you will need to know which insurance companies have a timely filing limit. so while you and your staff are treating patients, determine diagnosis codes, and submitting claims, you also have to keep track of all your contractor requirements.
Here are some of the most common payers and their timely filing deadlines.
Medicare has a 365 day timely filing limit
BlueCross BlueShield generally has a 365 day timely filing limit
Cigna has a 90-day timely filing limit
Medicaid has a 95 day timely filing limit
UnitedHealthcare has a 90-day timely filing limit
Without knowing these timely filing limits, it is common for providers to submit claims outside of the timely filing limit and then receiving a denial for those claims.
So what are some of the ways that you can avoid timely filing denials?
The first and most obvious answer to this question is to do your notes and submit claims for all of the day's sessions by the end of that day. by doing your notes and submitting claims within that day you avoid compliance issues, ethical issues, and you avoid one of the biggest denial reasons in medical billing.
In order to avoid timely filing denials you need a very clear structure for submitting claims and finishing your treatment notes. this means that if you have contracted employees you can include in your contract that they have to get their notes done by the end of the day and submit claims no later than 24 hours after the session has been completed.
If you have a biller you can require them to submit claims in a timely manner so that you know all claims are submitted within the timely filing limit.
But what if you aren't good at setting up those structures and what if you run into a timely filing denial?
Well, I would say that if you aren't good at setting up those structures you can hire a consultant to come in to help you build those processes. But ultimately you need to have system setup so that you don't run into these types of denials.
It is not uncommon to run into timely filing denials even if you were to get all your claims in on time. So the trick with timely filing denials is to get appeals to the insurance company as timely and accurate as possible.
When you do an appeal for timely filing you will want to include proof that you submitted a claim within the timely filing limit and that the claim was submitted correctly. Ultimately, the insurance companies going to request you to submit a corrected claim to fix the original submission.
You will want to monitor these denials as closely as possible so that you can recover those funds.
Here's some other tips to help when dealing with timely filing
Check each individual pears protocol. Some pears have timely filing appeal paperwork and others don't. You need to know this to advance to the next step
If you're submitting an appeal without designated paperwork gather proof timeless a mission. If you use an electronic health record you should have access to report that shows the date the claim is submitted
Once you know how to properly submit your appeal gather the following materials. a letter with the patient's name and date of birth and policy number, proof that you sent the claim it on time, a printed copy of the claim that was denied, and a copy of the explanation of benefits
Gather all of your paperwork and stapled together with the appeal letter on top
Send everything to the insurance companies claims processing department and make sure you have the right address so they can process your request quickly.
If you follow these simple steps you can either avoid timely filing all together or handle timely filing gracefully if and when it does happen. be sure to train your staff on all of the procedures and processes for the insurance companies that you are in network with and be sure to audit your claims processing regularly to ensure that you are being paid everything that you should be.
