If it is outside their “timely filing”, you will get a denial back. Now your only recourse is to rebill the claim. When you call to follow up, they will state, “we have no record in our system of having received that claim.” A large insurance company may receive over 100,000 claims a day and their systems cannot hold that volume of pending claims. After that, if they are not paid or denied, they are deleted from their computers. If the claim has been submitted within the TFL period, call customer care and request for Reopening the claim'Ī frustrating problem when doing account follow-up is that most insurance companies only hold or “pend” claims in their system for 60 to 90 days. If DOS has been wrong, resubmit with correct DOS It is also poor consumer relations to make the patient pay for your office’s failure to submit the claim.Ĭheck whether it has been billed within TFL period (One year from DOS) If you actually were outside the timely filing limit, many insurance companies and most provider agreements prohibit you from pursuing the patient for the denied balance. Medicare and Medicaid have specific appeal guidelines in their provider manuals, but other insurance companies vary. In these cases, you can appeal the claims, but you must call the insurance company and see what their appeal rights are. The only exceptions might be when you are dealing with a Medicare secondary and were appealing a denial prior to submitting to the secondary, or when an account was sent to work comp, then after much review was denied as not liable and now must be billed to health insurance. There should seldom be a time when claims are filed outside the filing limit. If you are a contracted or in-network provider, such as for BC/BS or other insurance like UHC, Aetna, the timely filing limit can be much shorter as specified in your provider agreement. If you file them later than the allowed time, you will be denied.įor most major insurance companies, including Medicare and Medicaid, the filing limit is one year from the date of service. Timely Filing Denial and Solution -Denial Code -CO 29 The time limit for filing has expired.Įvery insurance company has a time window in which you can submit claims.
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