What is a Timely Filing Limit and How Can it be Contested?

What is timely filing?

Denials for “Timely Filing”

In medical billing, a timely filing limit is the timeframe within which a claim must be submitted to a payer.  Different payers will have different timely filing limits; some payers allow 90 days for a claim to be filed, while others will allow as much as a year.  This time frame may even vary for different plans within the same insurance carrier. 

Payers set their timely filing limit based on the date of service rendered. If a claim is received after the specified date, the carrier will deny the claim with no patient responsibility.

As a medical billing company that services providers throughout the US, it is advisable to create a spreadsheet with filing limitations for the insurances in your state. Also, it is important to note that appeals for timely filing denials come with their own timely limits and should be listed on your spreadsheet. Finally, make sure you have timely filing limits for inpatient care because these limits may vary.

Can a denial for timely filing be contested?

Timely filing proof and backup

When a claim is denied for timely filing, this does not mean all options have been exhausted. If you actually filed a claim within the limits, you should certainly appeal. In this case, you will need to produce documentation to show proof that the claim was sent and received within the allowed time frame. This can include EDI logs and insurance correspondence.

However, if you did not file a claim in a timely manner, explain why. This is where a detailed letter explaining the situation is critical. AMPM has successfully appealed claims that were over 3 years old when we took over a new client’s Old AR.

Whatever your situation, acting fast can mean the difference between a paid claim and a write off. Get your facts organized on a cheat sheet, verify insurance coverage to make sure you are billing the claim to the correct primary carrier and most importantly, create workflows with checks and balances to make sure all encounters on the schedule are billed out.

Disclaimer: The materials contained on this website are provided for informational purposes only and do not constitute legal or other professional advice on any subject matter. Advanced Medical Practice Management does not accept any responsibility for any loss which may arise from reliance on information contained on this site.