Timely filing question

Jackie1973

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I'm trying to find out if we know for sure that a claim will be denied due to timely filing, do we need to file it or just do a timely filing adjustment? I would like anything in writing from the payors on this or anything I can give to Practice Management to back me up. Thanks so much
 

deborahtuck2010

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All timely filing info can be found on the individual payer websites. Medicare is 1 year from DOS, medicaid is typically 6 months from DOS, and most others are 90 days from DOS. I did not take adjustment until I got the denial because some of the smaller insurance plans will go ahead and pay the claim as long as you are not a habitual late filer. I hope this helped.
 

rthames052006

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I'm trying to find out if we know for sure that a claim will be denied due to timely filing, do we need to file it or just do a timely filing adjustment? I would like anything in writing from the payors on this or anything I can give to Practice Management to back me up. Thanks so much

Deborah is correct that you can find timely filing on the carriers websites, I recently created a grid for carriers with their filing limits and link to their website where I found the information for our billing department.

Also as Deborah mentioned most are 90 days but I've found a few that are 60 days as well. You will also want to check if the carriers have filing limits if they are secondary payor as well, the filing limits may be differant than if they are primary.

We've found that one carrier recently changed their timely filing limit so this is something you might want to check once a year, but most times if you get updates from your carriers that type of information will be mailed out to your offices or emailed in a carrier newsletter as an update.

Best of luck to you!
 

Jackie1973

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Thanks for the information. Yes I am aware of the different carriers policy but my question is, if you know that the claim is going to be timely do you have to file it to do the adjustment or just go ahead and adjust it off. Thanks I hope this makes sense..
 

LLovett

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File the claim, you can't always predict what carriers will do

What if they reject the patient wasn't even covered on the dos?

Just because it is past timely filing doesn't mean you have to write it all off, it depends on the payer on whether or not you have to write it off.

Medicare states that you can still bill the patient for their portion even if it is past filing limit.

Laura, CPC, CPMA, CEMC
 
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