Insurance will deny the claim with denial code CO 29 – the time limit for filing has expired, whenever the claims submitted after the time frame. The time limit is calculated from the date service provided. Each insurance carrier has its own guidelines for filing claims in a timely fashion. Some are as short as 30 days and some can be as long as two years. It is important to follow these guidelines or your claims may be denied for timely filing.
Claims are often denied for timely filing when the claim was actually submitted in a timely fashion but not received by the insurance carrier. There are many reasons this can happen, but the important part of the equation is how the biller responds to the denial. Other times, claims are denied for timely filing when they were not filed within the timely filing period due to initial mistakes.
Reasons for Claim Denials
The reason for a denial is when a claim is initially submitted with incorrect information. It may be a variety of things such as a typo on the part of the biller, it may be that the patient offered the wrong insurance card at the medical office, or it may be that when the information was transferred from the person who took the info to the person who is doing the medical billing and coding it wasn’t copied correctly. Lots of things can go wrong.
Appealing Timely Filing Denials
If your claim was denied for timely filing, and it was not ever submitted in the timeframe allowed, then it is more difficult to appeal. If you have a valid reason for not submitting the claim, you can appeal based on that. For example, if the patient stated that they didn’t have insurance because they thought that they were not covered at that time but then found out later that they actually were covered, and the claim is then submitted but after the filing deadline, you can try to appeal.
Write up a letter explaining exactly what happened, why the patient didn’t think they were covered, and what made them realize that they were. You’ve got a 50/50 chance, but it’s worth appealing. Basically, if you feel that you have an explainable and valid reason that the claim was not submitted in time, you can submit an appeal.
If there was any way that the claim could have been submitted in the timeframe, it will most likely be denied. But if you have a valid reason, it will most likely be overturned and allowed. It is important to file claims as quickly and timely as possible. But there are always things that come up that cause delays and timely filing denials do happen. If you have good systems in place, you will be able to appeal them quickly and efficiently and most will eventually get paid.
Submitting Proof of Timely Filing
Timely filing denials are often upheld due to incomplete or invalid documentation submitted with reconsideration requests. When submitting a request for reconsideration of a claim to substantiate timely filing, you can refer to the following instructions:
For claims submitted electronically:
- Submit an electronic data interchange (EDI) acceptance report.
- A submission report alone is not considered proof of timely filing for electronic claims. It must be accompanied by an acceptance report.
- The acceptance report must:
- Include the actual wording that indicates the claim was either ‘accepted,’ ‘received’ and/or ‘acknowledged.’
- Show the claim was accepted, received, and/or acknowledged within the timely filing period.
Other valid proof of timely filing documentation:
- A denial/rejection letter from another insurance carrier.
- Another insurance carrier’s explanation benefits.
- Letter from another insurance carrier or employer group indicating no coverage for the patient on the date of service of the claim
- All of the above must include documentation that the claim is for the correct patient and the correct date of service.
What happens if you fail to send out a claim within the timely filing limit? Unfortunately, that claim will get denied. 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. Instead, you have to write it off.
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