Our system provides a patient ledger which shows the original date billed, the most recent date billed and how many times the claim was submitted in total. If the claim was submitted on paper, your practice management system should provide you with some report showing the original submission date, and if the claim was submitted multiple times it should show each time submitted. If the claim was denied electronically you may even have that electronic denial, so that you can show what information was incorrect and that the claim was corrected and resubmitted. If the claim was submitted electronically then you can print an electronic report showing the original submission. The proof needs to be something that shows when the claim was originally submitted or when and how many times it was resubmitted. Whether you are using their form, or making your own, you should attach a copy of the claim, and your proof of timely filing to that form. Some carriers have special forms you must use, others don’t. Now, you have fixed the problem and resubmitted it with the correct info, but the carrier denies it for timely filing. It is best to work out a system for handling claim denials for timely filing and just follow that system every time you encounter this problem.įor example, you may have submitted a claim in the proper time frame and it was denied for a reason such as incorrect ID#, patient’s name was misspelled, or it was originally sent to the wrong insurance carrier.
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Lots of things can go wrong.Īt any rate, it doesn’t necessarily mean you won’t get paid for the services denied for timely filing, but you do need to know how to handle them. It may be a variety of things such as a typo on the part of the biller, it may be that the patient offered the wrong insurance card at the medical office, or it may be that when the information was transferred from the person who took the info to the person who is doing the medical billing and coding it wasn’t copied correctly. One reason for a denial is when a claim is initially submitted with incorrect information.
Other times, claims are denied for timely filing when they were not filed within the timely filing period due to initial mistakes. There are many reasons this can happen, but the important part of the equation is how the biller responds to the denial. Click here.Ĭlaims are often denied for timely filing when the claim was actually submitted in a timely fashion but not received by the insurance carrier. You'll have the right to a fast-track appeals process when you disagree with a decision that you no longer need services you're getting from a skilled nursing facility, home health agency, or a comprehensive outpatient rehabilitation facility.Ĭontact your State Health Insurance Assistance Program (SHIP) if you need help filing an appeal.Learn about the pros and cons of in-house billing vs.The hospital can't force you to leave before the BFCC-QIO reaches a decision. You'll be able to stay in the hospital at no charge while they review your case. If you believe you're being discharged from a hospital too soon, you have a right to immediate review by yourīeneficiary And Family Centered Care Quality Improvement Organization (Bfcc-Qio).Then, if your plan doesn't decide in your favor, the appeal is reviewed by an independent organization that works for Medicare, not for the plan. After you file an appeal, the plan will review its decision. The plan must tell you, in writing, how to appeal.If the plan or doctor agrees, the plan must make a decision within 72 hours. If you think your health could be seriously harmed by waiting for a decision about a service, ask the plan for a fast decision.If you decide to file an appeal, ask your doctor, health care provider, or supplier for any information that may help your case.
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