Need help scrounging up some evidentiary support? This Physicians Practice article offers a helpful suggestion on where to look: “Search the clearinghouse's website for proof that the claim was not just sent, but accepted by the payer.” Once you’ve done that, you can move forward with your appeal. For example, if you’ve submitted the claim in a timely fashion-but the insurance carrier didn’t receive it, the information was lost, or the payer “skipped” a date of service in a batch file-you do have the right to appeal to that payer for payment as long as you have proof.
The good news: There are some cases in which you can submit an appeal. The bad news: You typically cannot appeal such denials. Now, if you believed you had timely filing under control (Zamm!), but you just got hit with a timely filing-related denial (Thunk!), I have good news and bad news.
#Aetna medicare timely filing for corrected claim download
Now, if you’re wondering why the standard Blue Cross Blue Shield timely filing deadline quietly avoided this cheat sheet, hold on to your Batmobile, because we included the timely filing deadlines for 33 different BCBS offshoots in the download below! Keep in mind that while these are the payers’ standard filing deadlines, the deadlines listed in your individual payer contracts supercede these time frames 100% of the time. And like I always say, “With the right reminders, you can do almost anything-like squeeze into a suit with built-in abs.” Right? All super suits aside, here’s a payer deadline cheat sheet for participating providers, as adapted from multiple sources: But, you can use the chart below to remind you about your timely filing deadlines. So, how do you become a timely filing superhero? Well, unfortunately, there’s no sweet signal in the sky to warn you about timely claim submission danger. Furthermore, if you aren’t familiar with all of your timely filing deadlines and you end up submitting a claim late, you’ll be dealing with denials-the kind that typically can’t be appealed (Pow! Blap! Ouch!). So, while you and your staff are treating patients, determining diagnosis codes, and submitting claims, you also have to keep track of all your contracted requirements. That sounds simple enough, but the tricky part isn’t submitting your claims within the designated time frame it’s knowing what that time frame is, and that’s because there’s no set standard among all payers. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. Timely filing is when you file a claim within a payer-determined time limit. Whoops! I mean, check out these timely filing tips and download the cheat sheet below for reference. So, how do you know when your claim submissions are early, on time, or downright late? Look to the Bat-Signal for guidance, of course. Because with claim submissions, lateness isn’t only unacceptable it also causes denials. Or, maybe it’s because this rule truly applies in many situations-even in physical therapy billing. If you’re on time, you’re late.” Maybe I think that way because I have a Type A personality (holy organization, Batman). When it comes to punctuality, here’s my motto: “If you’re early, you’re on time.
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