Fine Tune Your Timely Filing Skills
Knowing the deadlines for each payer is key to success. Timely filing refers to the submission of a claim within a time period set by the payer. If a payer stipulates a 90-day timely filing requirement, it means the claim must be submitted within 90 days from the date of service. The challenge, however, isn’t just about submitting the claims within the specified period, but knowing what that period is, as it varies among payers. While you might already be busy with meeting claim quotas and querying providers, you’ll also need to be aware of all your timely filing deadlines to avoid denials. Continue reading to learn how to avoid timely filing denials in the future by staying organized and tracking your claim filing processes. Know Your Deadlines Plans and their deadlines for timely filing can of course change from year to year, so it’s important to make sure your practice is checking so you aren’t missing any important updates to these deadlines. Keep in mind that many plans have variations between commercial and private plan deadlines for timely filing, as well as deadlines that can be specific to each state. Employer-sponsored and Medicare Advantage plans may also have their own schedules for timely filing. For example, at the time of this publication, timely filing for payers like Medicare and Tricare is one year from the date of service, while some United Healthcare plans allow a short window of only 90 days. Speed Up the Process Very few offices still use paper claims and mail delivery to submit information, but it does happen. There are much faster and more efficient ways to make sure your claims are sent in a timely manner. Electronically submitting claims is the preferred method for payers. It’s faster and more efficient, while also reducing paperwork and errors. Many payers admit that they process electronic claims faster than paper claims because it’s less of a hassle. Track Your Claims Creating a spreadsheet to track your claims can be incredibly helpful and can keep you from missing a timely filing deadline. By tracking all your claim submissions and checking them each week, you can follow them through the system to make sure they are being paid promptly. This way, if you notice something has been held up, you have plenty of time to reach out to the payer to see what the issue is. Claim management software is also available and can be a useful tool to keep your claim submissions accounted for. Having a spreadsheet or using a program to track when your claims were submitted will help you in the long run, especially if you do need to appeal a denial due to timely filing. If you can produce documentation proving that the claim was sent to the payer within the allowed timeframe, that proves you held up your end of the contract, even if for some reason they didn’t receive it. Keep an Eye on Appeal Windows Just like timely filing deadlines, each payer has their own appeal deadlines, and you should familiarize yourself with them. These appeal windows may be between 60 and 180 days or as short as 30 days. Always look carefully at the appeal deadline when you receive a denial, as well as verifying that date with the individual payer’s preferences or your contract terms. Create Strong Appeal Letters A strong timely filing appeal letter serves as a powerful tool. It not only assists you in challenging a claim denial due to late submission, but also provides an opportunity to present evidence that either justifies the delay or proves the claim was indeed filed within the required timeline. This could potentially prompt the insurance company to reevaluate their initial denial. A well-crafted appeal letter demonstrates your proactive approach and seriousness about the claim, which could potentially expedite the insurance company’s handling of your case. Here are some helpful tips on how to format a timely filing appeal letter: Improve the Process Going Forward Keeping track of and evaluating which types of timely filing appeals are successful can save you time in the future. You can also streamline the process by saving the successful letter templates and changing out only the necessary information for future timely denial appeals. By scrutinizing the denials of your successful appeals, you can identify areas to concentrate on in the future and discern potential areas that need more training or attention. Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
Include any relevant contact information like your name, email address, phone number, the date you are writing the letter, the claim number you are addressing, and any denial reference number that was included from the payer.
Tell them why you are appealing the timely filing denial. Include dates the claim was submitted and state whether this was within their timely filing period or not.
This would be the time to explain if/why you filed a claim past timely filing and provide any supporting information. Also use this area to explain if you filed to the wrong payer in error, for example.
Ask that the payer kindly reconsider their decision to deny the claim and why you think that’s appropriate. Thank the payer for their time and ask that they reach out if they have any questions.
Remember to attach any proof the payer may need to reconsider their denial. These items may include the original denial letter, the original claim, and relevant notes. Include evidence of the timely filing period for that payer, like proof of electronic submission, clearinghouse information, or any other information you feel is helpful.
