Claim filed after time limit; Timely filing period expired; Claim request not submitted within 6 months of service date. These are all different ways for the payor to say the same thing: the claim didn’t make it to the claims department on time.
The best way to avoid this issue is to know the filing limitations for all of your payors. Warning: They are all different. Rule #1 - When your office staff verifies the patient’s benefits, make sure they find out what the claim filing deadline is. Make a notation in the patient’s file and most importantly, make sure that your billing department is aware of the deadline as well. The best course of action is to always file claims within 7 days of rendering treatment to your patients. However, if that is not possible, at least you will know exactly how much time you have to get your claim in.
The same attention must be given to appeal filing deadlines. Obtain the appeal deadline at the same time you verify patient benefits. That way, if you do receive a denial on a claim, the deadline information is already available. Always be armed with an awareness of filing deadlines!
With over 18 years of experience dealing with managed care issues and denied claims management, Michele is an expert at getting healthcare providers paid by managed care payors. As Senior Vice President of Provider Reimbursement for the Medical Claims Solutions Division in Delray Beach, Michele’s areas of expertise include reimbursement issues and denied claims appeals. She may be reached at (888) 455-4454 and mallen@FloridaHealthcareLawFirm.com.
