Importance of timely filing
Revenue and Cash Flow
what is submitting claim on time to ensure a steady revenue stream and helps maintain cash flow?
Identify the Payer
what is determining the specific insurance company responsible for the claim?
Timely filing
what is a denial that occurs when a medical claim is submitted to a payer after set deadline?
Medicare
what is 1 year from date of service?
Exceptions for timely filing
what is retroactive eligibility, administrative errors by the insurer, or other specific circumstances outlined in the provider’s contract?
Penalties
what is delays, lost reimbursement and damaged relationships with payers?
Payer's Contract
what is reviewing the individual contract with that payer to find their specific timely filing limit?
Timely filing
what is code CO-29 on an EOB?
Medicaid
what is 1 year from date of service?
Corrected claims
what is must adhere to the original timely filing limits unless specified otherwise by the insurer?
Minimizing Errors
what is submitting claims to helps catch and correct errors, preventing them from becoming timely filing issues?
Deadlines
what is the clock starts from the date of service?
Proof of Submission
what is Collect documentation, such as a clearinghouse report, to prove the claim was submitted and accepted by the payer within the deadline?
Cigna
what is 90 days from date of service?
Documentation
what is Providers should retain submission reports, acknowledgment receipts, or any electronic proof indicating the claim was filed within the required timeframe?
Training
what is Ensure billing staff are educated on the importance of timely filing?
Submit Claim
what is File the claim before the calculated deadline?
Missed opportunity
what is a denial for timely filing?
UHC
what is 180 days from date of service for Medicare and 90 days for Medicaid
Electronic claims vs Paper claims
what is can be submitted electronically or mailed within the insurers specified timely filing period?
Be proactive
what is Submitting claims early to allow for potential technical issues or mail delays, and to ensure the claim is received by the payer well within the deadline?
Verify Claim
what is confirm the correct payer received the claim?
Appeal
what is submitting proof of timely submission you can appeal the denial. For some claims, like certain Medicare exceptions, a specific waiver request and documentation may be required?
Humana
what is 90 days from date of services for Medicare and 1 year for Medicaid
Write offs
What is you will not get paid?