You may also want to make a copy of the Explanation of Benefits or Remittance Advice, on which your claim was denied for timely filing. You may find this tutorial on filling out the CMS-1500 claim form useful. This is so the insurance company knows the specifics of the claim, and so that they can process it directly. ( click here to skip to the sample appeal letter at the end of this article)Īfter you have printed out your appeal letter, you'll need to print out a paper version of the claim that was denied on an official CMS-1500 claim form. The next thing you need to do is write an appeal letter, which explains to the insurance company that you really did send the claim before the timely filing deadline, and that they need to pay the claim. Once you have your claims report, which contains the claims that were denied for timely filing, you can use this page as a means of support for your timely filing appeal. If this report doesn't have any type of date on it, you can't use it for your timely filing appeal. If, on the other hand, you really did send the claim within the timeframe, the next thing to do is make a copy of the report which says that you sent the claim, including the date that the claim was sent. This means you have to write it off as a direct loss to your office! If you didn't then you have no reason for appeal, and you cannot appeal the claim. The first thing you have to do is make sure that you really did send the claim within the timeframe. Once you receive a denial for timely filing, there is an important process to follow to send a timely filing appeal: You can use this report to support your timely filing appeal. When you send claims via your practice management system, make sure you print out your claims report, which says which claims went out on which days. You have proof that you really did send the claim within the timely filing deadline in the first place. This means that you have to write off the claim as denied for timely filing. You may not bill the patient for this balance." Usually the entire claim will be completely denied, with a reason stating something like: "This claim has been received past the timely filing deadline.
This means that even though you sent them to the right place and within the right time frame, they are lost in your electronic system and you never get a response from the insurance company.īy the time you have noticed and resent the claim, it was past the timely filing deadline, and your claim was denied for timely filing. Unfortunately, however, some claims simply get lost. Lets say that you have sent a batch of claims, checked them at the clearinghouse, and they have all gone out correctly. The clearinghouse reports as well as your internal claims reports can both be sent as proof of timely filing. The clearinghouse that you use may also generate reports that state which claims went out on which days, and to which insurance companies they were sent. If there are errors, the clearinghouse will send you a report to let you know what was wrong with your claims so you can fix and resend them.Ĭhecking your claims at the clearinghouse will help you make sure that all your claims are actually going out to the insurance companies, not just getting stopped at the clearinghouse.
See this article on medical billing clearinghouses for more on these services This clearinghouse checks your claims for errors and then sends them to the insurance company. Many of your claims will go out electronically to a claims clearinghouse, which is like a middleman between your office and the insurance company. This says which claims were sent and on which day. Typically, when you send claims through any type of practice management system, an internal report is generated. That you have documents to support the fact that you sent your claims within the timely filing deadline.That you actually have to send all of your claims within the timely filing deadline, and.In order to send a timely filing appeal, you have to have evidence to support your statement that the claim was sent within the timely filing deadline. If you've made sure that you have really sent your claims all within their timely filing limits, then you can send a timely filing appeal, and get your claims paid! Now that you know more about timely filing and how important it is to send your claims within the right timeframe, what do you do if some of your claims are returned because of timely filing?
#Aetna medicare timely filing how to#
Timely Filing Appeals - How to Send + Example LetterĪ sample appeal process and letter based on a timely filing denial.Ĭlick more information on what timely filing is and how it can affect the processing of your claims
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