Navigating Timely Filing Denials: A Comprehensive Guide

We’ll delve into the intricate world of timely filing denials. Before we explore strategies to address these denials, let’s first understand what the term “timely filing limit” entails.

Understanding Timely Filing Limits

Timely filing limits refer to a specific time frame within which a medical claim must be submitted to the insurance. For instance, if there’s a 90-day timely filing limit (TFL), the medical claim must be submitted within that period. Failing to do so results in the insurance denying the claim as the TFL has expired. It’s crucial for healthcare providers to submit claims within the designated time frame to ensure successful processing by the insurance.

Key Definitions

Date of Service:

The date on which a service is provided to the patient is known as the “date of service.” For example, if a patient meets a doctor on January 1st, 2021, the service given on that date is considered the date of service.

Proof of Timely Filing Limit (POTFL): This refers to a document or evidence supporting the reason why a claim was submitted after the timely filing limit. Examples include denied Explanation of Benefits (EOB), clearinghouse reports, certified mail receipts, and fax confirmations.

Common Examples of POTFL

Denied EOB:

If a patient has multiple insurances, and a claim is initially submitted to Insurance B as the primary, but it gets denied because Insurance B is not the primary, the denied EOB from Insurance B can serve as POTFL for an appeal with Insurance A.

Steps to Address Timely Filing Denials

Know the Timely Filing Limit

Understand the specific timely filing limit for each insurance to submit claims within the allotted time.

Verify Claim Received Date

Check with the insurance representative for the claim received date to ensure they received the claim within the timely filing limit.

Adjust for Correct Denials:

Check with the insurance representative for the claim received date to ensure they received the claim within the timely filing limit.

Reprocess for Incorrect Denials:

If a claim is denied incorrectly, reprocess the claim or initiate a call for resolution. Incorrect denials are rare but should be addressed promptly.

Dispute with POTFL:

If a claim is denied for TFL reasons, and you have proof of timely filing, such as a denied EOB, dispute the denial with the insurance, stating your right to appeal with the provided proof.

Conclusion

Timely filing denials are a common challenge in medical billing , but understanding the limits, dates, and necessary documentation can empower healthcare providers to navigate these challenges effectively. Remember, proactive management and attention to detail play a crucial role in minimizing denials and ensuring a smooth billing process.

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