How to Avoid Denials: Timely Filing for Pediatric Therapists

May 1, 2018 4:42:35 PM

Sometimes it feels like payers are looking for any reason they can find to deny your claims. Make sure you don't give them one! Paying attention to timely filing limits is one way to ensure that your claims are paid.

What is Timely Filing?

Timely filing refers to the time limit to submit a health insurance claim. These requirements are put in place by insurance payers to require that claims be filed within a certain period of time.

If you don't get your claim in on time, I bet you can guess what happens. That's right! It gets denied.

Unfortunately there isn't a single time limit for all payers. Each one has their own filing limit, so you'll need to get that straight to avoid claim denials.

Pediatric Therapy EMR

Timely Filing Limits by Payer

Here are the filing limits for some of the more popular payers. (Don't take our word for it. This information can change. Make sure you double check these!)

  • Medicaid: 365 days from the date of service
  • Tricare: 365 days from the date of service
  • Blue Cross/Blue Shield: 365 days from the date of service
  • Cigna: 90 days from the date of service (in-network); 180 days from the date of service (out-of-network)
  • Health Net: 365 days from the date of service

Denied for Timely Filing?

If your claim is incorrectly denied for timely filing (for example, if you filed within the time limit, but had to make corrections), you'll need to submit proof. And like so many other things with insurance payers, every one requires different proof.

Proof of Timely Filing

Typically you'll need to send a copy of the claim, and some sort of documentation that proves when and how many times you submitted it. This could be a letter from the clearinghouse and/or an internal report from your billing software.

Proof of Timely Filing Appeal Letter

What if a claim was denied for timely filing? Then what action would you take to try to get the claim paid?

You'll need to file an appeal letter, and then follow up with the insurance company to make sure they received it. The process can take four to six weeks.

Stay on Top of Your Claims!

Don't let billing mistakes hurt your bottom line. Research the timely filing limits for each payer you work with, and use therapy software like Fusion Web Clinic's Task Manager to make sure you don't forget.

In-House Billing Kit

We've put together some resources to help you bring billing in-house. This In-House Billing Kit includes:

  • A Verification Questionnaire to use when calling payers to verify coverage
  • A 50% off coupon for our billing course, The Essentials of Insurance Billing for Therapy
  • A Billing & Collections Checklist to guide you as you interact with caregivers
  • A Payment Policy Generator to help you set expectations for caregivers
  • 7 Tips to Help with Billing & Collections handout
In-House Billing Kit

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