How to Minimize Timely Filing Denials

Your team collected a patient’s information at the time of their visit. The clinical documentation was thorough, and the proper billing codes were assigned. A claim was submitted.

And then, the claim was denied.

Sound familiar? One likely culprit for such denials is timely filing. In medical billing, timely filing refers to the timeframe in which healthcare providers must submit claims to a payor for reimbursement. Each insurance carrier has its own guidelines around timely filing limits, ranging from 30 days to over a year.

It is crucial that healthcare providers understand the guidelines of each payor and take appropriate measures to avoid denials for timely filing.

Here are a few helpful tips to set your team up for success:

1. Be Aware of Payor Time Filing Limits

This can vary not only from state to state, but also within the individual provider contract. Familiarize yourself with each payor’s contract so there are no surprises. It’s important to note that, in addition to the initial claim submission deadline, payors may have separate deadlines for submitting correcting claims and appeals. Creating a quick reference guide breaking down each time file category can help you keep everything straight. Plus, it will help you prioritize working payors that have a short time file.

2. Collect Accurate Patient Information

During the registration and verification process, be sure to verify the patient’s plan and information. Failing to verify polices at the time of service can result in not only delay in payment, but also a timely filing denial if the new insurance is obtained after the payor’s deadline.

It’s important to submit claims to the insurance carrier as soon as possible after services are rendered. An established workflow makes this significantly easier, helping to ensure that all charges are sent to the insurance companies. For instance, you can develop a missing charges report using the practice’s schedule to ensure all charges are filed. From there, make sure that all front-end clearinghouse rejections are worked in a timely manner, and keep records of all claims acceptance reports in the event that a timely filing denial needs to be appealed.

This is a critical step in avoiding timely filing denials. Work the payors with shorter time file requirements first, allowing yourself ample time to make any necessary corrections and still fall within the payor’s time file requirements. Since many payors have different time file requirements, aim to follow up on all claims and appeals within 30 business days to ensure proper payment.

If a claim is denied for timely filing, it does not always need to result in a write off. There are often circumstances that timely filing denials can be appealed. Below are a few things to consider in that process:

• Appeal with the acceptance report that indicates that the claim was either “accepted,” “received” or “acknowledged.” This will indicate to the payor that the claim was transmitted without any errors.
• Denial explanation of benefits (EOB) from the patient’s other insurance carrier. If the patient presented the wrong insurance at the time of service, provide the payor with the EOB indicating that the patient’s plan was not active.
• Request a one-time timely filing exception from the payor.

While appealing does not always guarantee payment, it is worth the effort to try to overturn the denial and receive payment.

Remember, it is crucial to file claims promptly to avoid delays. With effective systems in place, you can stay within payor guidelines and, when unexpected issues do arise, handle them quickly and efficiently to optimize your chances of the claim being paid.

Nicole Clemens is a Revenue Cycle Manager at Medic Management Group. Nicole manages a team of employees who provide revenue cycle support to a number of MMG clients, including large multi-specialty groups and anesthesia groups. MMG is a national provider of advisory and consulting competencies, transaction support services, and back office administrative support to independent and system owned physician practice groups.