![]() They will help practices keep track of all of their contracted requirements, verify patients’ coverage details before services are provided, and ensure timely claim submission and payment. Reliable companies have well-trained personnel on board who can manage all phases of the revenue cycle efficiently. Outsourced medical billing services are a practical option to avoid this risk and maximize revenue. Timely filing denials can leave a lot of revenue on the table. If the claim meets the criteria for one of these exceptions, review can be initiated by sending a request letter along with supporting documentation. Medicare timely filing claim denials can only be appealed based on certain exceptions. Medicare timely filing denials are not subject to formal appeal. Timely Filing Policy Participating provider claims submitted three (3) months 90 days after the date of service OR out-of-network claims submitted six (6). In most cases, the claim will be paid after a review of the appeal, which usually takes 30-90 days. The letter appealing the denial should contain the necessary patient information along with the proof that the payer had accepted the claim and wrongfully denied. If a claim is denied for timely filing, Physicians Practice recommends searching the clearinghouse’s website for proof that the claim was not just sent, but accepted by the payer. Even if a claim is sent before the end date, but is received after that date, it will still be denied. Staff is knowledgeable about claim submission deadlines listed in MA and commercial payer contractsįailing to send out a claim within a payer’s timely filing limit will result in denial.Proper insurance eligibility verification before the patient’s office visit.Preventing /Handling Timely Filing Claim DenialsĪ shorter time limit for filing claims means that physicians’ offices need to ensure: In other words, as CGS Medicare instructs, “Providers should check with the individual MA Plan to determine their timely claim filing requirements”. If a patient has switched from a traditional Medicare plan to a MA Plan, the medical billing service provider needs to follow the timely claim filing rules for that particular MA plan. ![]() However, the rules could be different for a Medicare Advantage (MA) Plan.
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