Understanding claim timely filing requirements
Claim timely filing limit is a specific period during which a provider may submit an insurance claim for the rendered services to the payer. In most cases, this period is defined by the number of calendar days since the date when a procedure has been performed. Should a claim be submitted outside of this timely filing period, it will inevitably be denied, unless proof of timely submission has been provided to a payer.
There is no general timely filing limit that could be used both by Medicare/Medicaid and commercial plans. Each insurance, and sometimes even a plan within insurance, has its own requirements on timely submission of claims. Healthcare providers and related entities must check the regulations of each payer prior to submitting a claim. Proper verification of this aspect is critical for a flawless reimbursement. However, there is a certain pattern used by the majority of health plans. Knowing this pattern eliminates the need to calculate an acceptable filing deadline for each payer.
Payers normally allow an insurance claim to be submitted within 90 days from the date of service. Most commercial policies, as well as the New York State Medicaid, follow this pattern. With that in mind, you should consider 90 days as a standard timeframe for you to submit your claims.
However, there are some notable exceptions. For example, Medicare allows healthcare providers to send a claim within 1 calendar year since the date of service. Commercial plans like GHI and Aetna have a 120-days timely filing limit for most of their plans. In addition, if you submit a claim through an IPA or a network management organization (such as the NYNM), you only have 60 calendar days. Such a comparably short period is needed for an IPA to forward your information to a payer.
WCH Billing Department specialists ensure timely submission of your billing. We check & submit your claims within five business days since the moment you have provided the documentation to us. However, it is still critical for you to provide your claims to us within an applicable timely filing limit.
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