Medicare timely filing denials are not subject to formal appeal. 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. Uncertain about policy period or start and end dates.Cannot find their MA plan card and produce their original Medicare card.Unaware who their primary payer and secondary payer are.According to a recent Find-a-Code article, the one-year time limit helps sort out issues that may occur when patients are unsure of their coverage details, including: This rule applies to the Medicare FFS program (Traditional or Original Medicare) and claims that do not meet this deadline risk denial. ![]() ![]() Medicare’s rule for timely filing is: “Claims must be filed to the appropriate Medicare claims processing contractor no later than 12 months, or 1 calendar year, after the date the services were furnished.” The end date for timely filing for the original or traditional Medicare Fee for Service (FFS) plan is exactly one full calendar year after the start date. This means all claims submitted on or after Octowill be subject to a ninety (90) day timely filing requirement.Ĭheck Timely Filing Requirements of Individual MA Plansįor a Medicare claim, the “Start date” or “From date” recorded on the form is the Date of Service (DOS), the date when a provider performed healthcare services or procedures. 1, 2019, your Anthem Blue Cross and Blue Shield (Anthem) Provider Agreement(s) will be amended to require the submission of all commercial and Medicare Advantage professional claims within ninety (90) days of the date of service. The company’s notification was as follows:Įffective for all commercial and Medicare Advantage Professional Claims submitted to the plan on or after Oct. ![]() On June 21, 2019, Anthem Blue Cross notified their network and contracted Medicare Advantage (MA) providers about a shorter timely filing limit that will become effective as of October 1, 2019. Timely filing with the correct codes is critical for timely and appropriate payment.Īnthem reduces Timely Filing Deadline for Claims For instance, if the insurance company has a 90-day timely filing requirement, physicians’ offices need to submit the claim within 90 days of the date of service. Timely filing is when a payer fixes a time limit for claims submission. ![]() When submitting Medicare claims, a medical billing companyshould know the details of the timely filing rule, which can differ from payer to payer. The recent announcement by Anthem Blue Cross about changes in timely filing limits for Medicare Advantage plans points to the importance of efficient insurance eligibility verification and claim filing for successful medical billing.
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