Difference between appeal limit and filing limit in medical billing

In medical billing, a timely filing limit is crucial because of the deadlines set by the insurance  companies for the service rendered. If a claim gets submitted after the deadlines, it gets denied as  the timely filing limit expired, and you could lose some serious revenue. The denial code CO29  explains the expired time limit. Health insurance companies have their guidelines, and usually, the  timely filing limit ranges from 30 days to 1 year from the day of service. You can find timely filing  limits under the claims section in the provider manual.  

The insurers are not responsible for late claims. As a provider, it is your responsibility to understand  and follow each payer’s guidelines. The claim denials can happen due to incorrect information  either shared by the patient at the medical office or typo mistakes by the biller or copied incorrectly.  

How to reduce these denials? 

Ensuring the team is familiar with the limits for the insurer before your patient visits your office will  help in submitting claims on time without losing revenue.  

Even after submitting a timely claim, you can still receive CARC 29 (Claim Adjustment Reason  Code). In reality, sometimes, the insurer lost or never received the submitted claim. In this case, a  timely filing report by the clearinghouse lists the claim submission date to the payer and the  clearinghouse. Submit this report to the insurer as an appeal to overturn the denial thus you don’t  lose money.  

Appealing in Medical Billing 

An appeal is a request to reconsider the claim with supporting and rational documentation. As a  provider, it is good to know how the appeal process is different from a request for follow-ups in  case of claim denial for timely filing. You can only appeal if you have a valid reason for not  submitting the claim in the first place. Otherwise, it is more difficult to appeal. With an explainable  reason, it is most likely to be allowed, in that case, to submit claims as efficiently as possible to get  paid. The law permits you to file an appeal, and as a denied claim, it will get a second look by the  insurer who wasn’t involved initially.  

To illustrate, if the patient was not sure about the insurance coverage and stated that they didn’t have  any plan. Later found out that they can be covered and thought of mentioning them after the claim  submission. That calls for an appeal after the filing deadline. Write an appeal letter explaining the  reason for the delay, and if there was any way for timely filing claim submission, chances that the  insurance claim gets denied. If you have a robust system in place and the documentation provided  supports the claim. You will be able to appeal quickly, and the timely filing gets waived. Be sure to  check the state’s pay statutes to avoid claim stalling. You can always ask for help, filing an appeal  through an independent third party so that you get paid for the rendered services.