Health insurance companies have guidelines they want medical offices or medical billing services to follow. One rule is that claims are sent out within a certain number of days of the service(s) rendered to be eligible for payment.
Timely Filing Limits Differ Between Health Insurance Companies
All the major insurance companies in the United States do not have the same timely filing limits. Medical management and medical billing services must know the guidelines for submitting insurance claims to ensure receipt of payment for services.
United Healthcare (UHC)
Under “time limits for filing claims,” you can see that UHC has a limit of “at least 90 days for participating care providers and 180 days for non-participating care providers from the date of service to submit claims.”
It is important to note: “If a network care provider fails to submit a clean claim within the outlined timeframes, we reserve the right to deny payment for such claim. You cannot bill a member for claims denied for untimely filing.”
As stated on AAFP, the time limit for Anthem plans to receive claims reduced to 90 days as of October 1st, 2019. It is also important to note: “A shorter time limit for filing claims increases the importance of two office functions. First, you and your staff obviously have to be efficient about filing claims. Second, you have to accurately verify a patient’s insurance before or at the time of appointment because if you send an Anthem claim to the wrong insurer, you may not have time to send it again.”
Like UHC, Cigna gives a 90-day limit for participating healthcare providers and a 180-day limit for all out-of-network providers. Again, you cannot invoice Cigna members for denials due to late submission. You will also want to be sure to understand the list of “deadline exceptions” that can aid in claim filing.
Under “time frames to submit a claim, Humana Medicare Advantage claims have “one year from the date of service or as stipulated in the provider agreement.” All commercial claims have a limit of “90 days from the date of service if no other state-mandated or contractual definition applies.”
It’s good to note that “if a claim is submitted in error to a carrier or agency other than Humana, the timely filing period begins on the date the provider was notified of the error by the other carrier or agency.”
To file a claim with Medicare, providers and medical billing offices have “12 months (or 1 full calendar year) after the date when the services were provided.” By not adhering to the timely filing deadline period “Medicare can’t pay its share.”
Untimely Filing is a Common Reason for Claim Denial. Why?
Missing the submission deadline date is one of the top reasons for medical claim denials. If your practice is not getting reimbursement due to the untimely filing of insurance claims, it’s critical to know why.
- Are patient visits well documented for coding accuracy?
- Are coding questions promptly being addressed?
- Is there a need for additional training in coding and billing?
- Are bills going out every day?
- Is your billing system labor intensive?
Medical Software Offers Administrative and Clinical Efficiencies for Timely Filing
To help in getting claims out as quickly as possible, it may be time to mitigate risk by reviewing your practice operations, both administrative and clinical. With today’s technology capabilities, medical practices have the opportunity to invest in “practice management software and electronic medical records (EMR) systems.” When the two systems work seamlessly together, your practice has the opportunity to realize benefits across the board.
- “Coordinated Operations”
- “Automation and Efficiency”
- “Integration with EMR Systems”
- “Billing and Financial Analysis”
- “Patient Communication”
A successfully operating practice will also benefit from a powerful online presence, and we invite you to get to know us at Creosen. We will help you develop or upgrade to an interactive website to offer valuable health information to your patients and market your practice for prospective patients to find you and get to know your team.