When claims are submitted beyond the time limit, insurance will refuse the claim with denial code CO 29 – the time limit for filing has expired. The time limit is computed based on the date of service provision. Each insurance company has its own rules for reporting claims on time. Some are as brief as 30 days, while others might last up to two years. It is critical to follow these criteria; otherwise, your claims may be denied for failure to file on time.
Claims are frequently denied for failure to file on time, even when the claim was submitted on time but not received by the insurance provider. There are several reasons for this, but the most crucial factor is how the biller responds to the denial. In other instances, claims are denied for failure to submit on time because they were not filed within the timely filing period due to original errors.
Why Are Claims Denied?
A claim is denied when it is first filled with erroneous information. It could be a variety of things, such as a biller’s typo, the patient is given the incorrect insurance card at the medical office, or the information not being appropriately copied when it was transferred from the person who took the lead to the person who is doing the medical billing and coding. Many things can go wrong.
Appealing Timely Filing Denials
If your claim were refused for failure to file on time and never filed it within the timeframe permitted, it would be more difficult to appeal. You may file an appeal if you have a good cause for not filing the claim. For example, if the patient said that they did not have insurance because they were not covered at the time but later discovered that they were, and the claim is submitted, but after the filing date, you might try to appeal.
Write out a letter outlining what happened, why the patient didn’t think they were covered, and what made them understand they were. You have a 50/50 chance of success, but it’s worth appealing. Essentially, you can file an appeal if you believe you have an explainable and reasonable cause why the claim was not submitted on time.
It would certainly be refused if the claim could have been made within the period. However, if you have a good explanation, it will be reversed and approved. It is critical to file claims as soon and as thoroughly as possible. However, things may arise that cause delays, and timely filing denials occur. If you have solid protocols in place, you will be able to appeal to them swiftly and efficiently, and most of them will be paid ultimately.
Proof Submission of Timely Filing
Due to insufficient or inaccurate paperwork supplied with reconsideration petitions, timely filing denials are frequently upheld. You might refer to the following procedures when requesting reconsideration of a claim to demonstrate timely filing:
Electronically Submitting Claims:
- Submit an acceptance report for electronic data exchange (EDI).
- A submission statement does not create proof of timely filing for electronic claims. A report of acceptance must accompany it.
- The acceptance report must include the exact phrase indicating whether the claim was ‘accepted, “received,’ or ‘acknowledged.’
- Demonstrate that the claim was accepted, received, and acknowledged within the time limit for filing.
Proof of Timely Filing Documentation:
- A letter of denial or rejection from another insurance company.
- Another insurance company explains the benefits.
- Letter from another insurance company or employment group showing that the patient did not have coverage on the day the claim was filed.
- All of the above must be accompanied by evidence proving that the claim is for the proper patient and date of treatment.
What happens if you fail to submit a claim within the time limit? Unfortunately, such a claim will be refused. Check the terms of any of your insurance company contracts. You’ll almost definitely find a condition stating that the payer isn’t responsible for any claims received outside of its timely filing limit. As a result, if you miss the deadline, you will be unable to bill the patient or file an appeal with the payer. Instead, you must write it off.
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