Medical Payers' Timely Filing Deadlines

With the New Year underway, it's time to stop and review your payer contracts, particularly the timely filing deadlines. Why is this important? Payers have specific deadlines within which you can submit claims. Bypass these deadlines and you can kiss that revenue goodbye.

Your billing department receives electronic and paper explanation of benefits from the insurance companies. When the denial reason code states "timely filing exceeded," you have no appeal rights, if that is indeed true. Oftentimes, insurance companies accept electronic bath files that include multiple dates of service. They will pay the first two, skip the third, and pay the fourth and the fifth date of service. That third date will eventually be denied for exceeding timely filing if it is not rebilled within a specific time frame stated by the payer. I call this a delay tactic by the payer. Deliberate or not, they are delaying payment to you, the provider, because their system did not accept that missed date of service.

Most billing companies use a clearinghouse to send claims to payers, which batches them together in one large file that the insurance company receives, reviews, and hopefully pays. If you have found that you are being denied for timely filing, search the clearinghouse's website for proof that the claim was not just sent, but accepted by the payer. This is when you are allowed to appeal this denial. Writing a brief letter with the patient's name, date of birth, policy number, etc., along with your proof that the payer had accepted the claim and wrongfully denied it will get that claim paid for you. Most payers ask for 30 days to 90 days for review of appeals, but with this proof, you should be paid.

Below are some of the larger payers' timely filing deadlines - print this out and keep it handy:

• Medicare: 365 days from the date of service

• Blue Cross/Blue Shield: 365 days from the date of service

• Cigna: 90 days from the date of service

• Medicaid: 95 days from the date of service

• United Healthcare: 90 days from the date of service

• Health Net: 120 days from the date of service

• Secure Horizons: 90 days from the date of service

These are a few examples - you can always visit a payer's website under the PROVIDER section and find what their timely filing deadline is. It's a great idea to have this information handy, particularly if you work for a larger organization that bills out on a monthly basis.

Oftentimes, providers may not follow up on visits that were never coded and billed. A good EHR system will allow you to run a report that shows "appointments without associated charges," that could help your administrator follow up on missing claims much easier. It doesn't take much for missing claims to get out of control, and end up leaving a tremendous amount of revenue on the table.