When it comes to punctuality, here’s my motto: “If you’re early, you’re on time. If you’re on time, you’re late.” Maybe I think that way because I have a Type A personality (holy organization, Batman). Or, maybe it’s because this rule truly applies in many situations—even physical therapy billing. Because with claim submissions, lateness isn’t only unacceptable; it’s also a cause for denials. So, how do you know when your claim submissions are early, on time, or even unacceptable? Look to the Bat-Signal for guidance, of course. Whoops! I mean, check out these timely filing tips and download the cheat sheet below for reference:
Timely filing is when an insurance company puts a time limit on claims submission. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. Sounds simple enough, but the tricky part isn’t submitting your claims within the designated time frame; it’s knowing what that time frame is. That’s because there’s no set standard among all payers. So, while you and your staff are treating patients, determining diagnosis codes, and submitting claims, you also have to keep track of all your contracted requirements. Furthermore, if you aren’t familiar with all of your timely filing deadlines, and you end up submitting a claim late, you’ll be dealing with denials—the kind that typically can’t be appealed (Pow! Blap! Ouch!).
So, how do you become a timely filing superhero? Well, unfortunately, there’s no sweet signal in the sky to warn you of timely claim submission danger. But, you can use the chart below to remind you of timely filing deadlines. And like I always say, “With the right reminders, you can do almost anything—like squeeze into a suit with built-in abs, for example.” Right? All super suits aside, here’s your payer deadline cheat sheet, as adapted from this resource:
|Payer||Timely Filing Deadline|
|Medicare||365 days from date of service|
|Blue Cross Blue Shield||365 days from date of service|
|Cigna||90 days from date of service|
|Medicaid||95 days from date of service|
|UnitedHealthcare||90 days from date of service|
|SecureHorizons||90 days from date of service|
|Health Net||120 days from date of service|
Download your Timely Filing Requirements Cheat Sheet.
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Now, if you believed you had timely filing under control (Zamm!), but you just got hit with a timely filing-related denial (Thunk!), I have good news and bad news. The bad news: you typically cannot appeal such denials. The good news: there are some cases in which you can submit an appeal. For example, if you’ve submitted the claim in a timely fashion, but the insurance carrier didn’t receive it, the information was lost, or the payer “skipped” a date of service in a batch file, you do have the right to appeal to that payer for payment—as long as you have proof. Need help? This Physicians Practice article offers a helpful suggestion on where to look: “Search the clearinghouse's website for proof that the claim was not just sent, but accepted by the payer.” Once you’ve done that, you can move forward with your appeal. Here’s how, as adapted from these Physicians Practice and MB-Guide articles:
- Check each individual payer’s protocol. Some payers have “timely filing appeal” paperwork, and others don’t. You need to know this to advance to the next step.
- If you’re submitting an appeal without designated paperwork, gather proof of timely claim submission. If you use a practice management system, you should have access to a report that shows the date your claim was submitted. Be sure to print this page.
- Note: a handwritten note isn’t sufficient proof of timely submission. The document has to be system-generated and tamper-proof.
- Once you know how to properly submit your appeal, gather the following materials:
- A letter with the patient’s name, date of birth, policy number, and any other pertinent information stating why you’re submitting an appeal
- Proof that you sent the claim on time (e.g., the report that shows that you sent the claim and indicates the date that the claim was sent)
- A printed copy of the claim that was denied
- A copy of the explanation of benefits or remittance advice that shows why the claim was denied (this is optional, but may help expedite the appeals process)
- Gather all of your paperwork, and staple it together with the appeal letter on top.
- Send everything to the insurance company’s claims processing department. Make sure you have the right address so they can process your request quickly.
Once you’ve sent in your documentation, it could take anywhere from 30 to 90 days for the payer to review the appeal. However, if you include all of the information noted above, and your claim actually was submitted on time, you should eventually receive payment.
So, what happens if you fail to send out a claim within a payer’s timely filing limit? Well, unfortunately, that claim will get denied. And I’m no joker. That’s because, if you look at the terms of any of your insurance company contracts, you’ll almost certainly see a clause indicating that the payer isn’t responsible for any claims received outside of its timely filing limit. Thus, if you miss the deadline, you can neither bill the patient for the visit nor appeal to the payer. Unfortunately, you have to write it off.
So, if you find you’re having trouble submitting your claims on time, resist the urge to retreat to the Batcave. Instead, download and print our timely filing cheat sheet so you have it available for reference. Because the only thing better than submitting your claims on time is submitting them early. (Pow! Am I right?)