HOW TO HANDLE TIMELY FILING CLAIM DENIALS
A big challenge medical billers are most often confronted with is handling claims denied due to timely filing issues, as each insurance company wants the deadline set by it observed doggedly.
The length of these deadlines for filing insurance claims is not fixed. They can vary from as short as 30 days to two years. You must adhere to these timelines, or your claim could be rejected because it was not filed promptly.
Claims may be rejected even if submitted on time but not received by the insurance provider. Various causes can lead to this situation, and it’s crucially important to know how the biller reacts to such denials.
Reasons for Claim Denials
The initial submission of a claim with wrong information. Errors leading to claim denials due to timely filing can happen for several reasons:
- Incorrect Information on Initial Submission: This could be the wrong input by the biller, for instance, typing the wrong patient number or insurance number.
- Incorrect Insurance Information Provided by the Patient: The patients may present invalid or incorrect insurance cards on the day of the visit, and therefore, claims may be wrongly submitted.
- Miscommunication During Data Entry: When passing information from the intake staff to the medical billing and coding department, errors could spill into the claim information.
Nevertheless, not being paid for untimely filed claims is not always unavoidable. Therefore, to take care of such cases and improve the overall performance when a claim denial due to late filing is received and appropriately needed procedure was followed every time such incidents happened. This approach increases the chances of better results and reduces avoidable costs, which may affect company revenues.
Errors Caused by Submissions: Resolving Claim Denials
A frequent challenge in medical billing is the submission of error claim denials. These issues are often due to poor patient data, such as the spelling of a patient’s name, incorrect ID number at the time of service, or an expiring insurance card. Another standard error is submitting claims to the wrong insurance carrier. Even after such errors are identified and corrected promptly, resubmitted claims may be denied due to being filed late.
This can frustrate billing teams, especially if the original submission was within the allowed timeframe. A systematic pattern of denial addressing these denials requires that the root cause be identified and the corrected claim be shown to receive all carrier requirements. Knowing the carrier-specific rules regarding handling denials is essential because each insurer has different rules. Good communication, recording the details to the best of your ability, and having a proactive strategy can help delay and hopefully reverse the denial.
Proper Documentation to Strengthen Appeals
You must provide solid evidence when appealing the denial due to timely filing to get accepted. Even if claims weren’t submitted on time and errors were made, insurance carriers tend to require proof that they were initially submitted on time. Critical evidence is submission reports (denial notices) showing the initial attempt on electronically submitted claims. Paper systems produce detailed practice management reports for submission dates and corrections when claims are made. They are unalterable records widely accepted by carriers as valid proof.
A well-documented appeal letter discussing the reason for the appeal complimented with supporting evidence, strengthens the appeal. Some may require forms or formats to ensure every carrier has its appeal procedures. Maintaining accurate documentation and keeping records organized will help you show compliance with filing requirements and will make it more likely that you’ll receive a recovery of your denied payments.
Appealing Timely Filing Denials
If your claim was rejected for timely filing, which means it wasn’t submitted within the permitted time frame, then appealing becomes tougher. You can only appeal if you have a good reason for not submitting the claim.
For instance, if the patient says they didn’t have insurance because they believed they were not covered at that moment but learned after submitting the claim that they genuinely had coverage. It has been filed, but it is beyond the time limit for submission. You may try to appeal.
Compose a letter that describes all the details of what occurred, why the patient believed they were not covered, and what caused them to understand they were. You have an even chance, so it is beneficial to appeal.
Simply put, you can appeal if you think there is a logical and acceptable reason why the claim was false. It would probably be denied if there was no way to submit the claim within the time limit However, if you have a valid reason, this denial could get overturned, and your claim might be accepted.
Conclusion
Medical billing can present a frustrating challenge with the timely filing of claim denials. When they know the typical causes, such as submission mistakes or miscommunication, and when they stick to the systematic routines for appeals, billers can resolve these issues. Submission reports and detailed appeal letters will increase your case strength and odds of winning denied payments. Filing on time is essential, but delays can occur at the last minute. Healthcare providers can minimize the impact of these denials and protect revenue while continuing to do so operationally through organized processes, clear communication, and proactive strategies.
