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What are timely filing limits?

Healthcare providers in San Antonio (such as yourself) rely heavily on insurance reimbursement to be able to continue to serve their patient populations. It could easily be said, then, that you are somewhat at the mercy of insurance companies and their policies. Dealing with claim denials is a constant struggle for providers in your position. This struggle can be compounded even further in that the longer it takes to get claims resolved, the greater the potential that you encounter timely filing issues. 

Timely filing refers to the standard that insurance companies hold providers like yourself to for getting claims submitted. These time limits are meant to expedite the claim process. If you do not meet them, claims will not be covered. What is more, you typically cannot bill patients for claims that were denied due to timely filing. According to the Modern Medicine Network, the timely filing deadlines for some of the more common carriers are as follows: 

  • Medicare: 365 days
  • Blue Cross/Blue Shield: 365 days
  • Medicaid: 95 days
  • United Healthcare: 90 days

Timely filing periods typically begin on a patient's date of service. 

If you were not able to file a claim within the timely filing period, your options for a appealing a denial may be limited. The only exception to this may be if the patient was not aware that he or she was covered on the date of service, in which case you can present that evidence to the insurer. If, however, an insurer denied a claim for another reason and you were in the process of appealing its decision, it cannot then deny a claim for timely filing if that time period lapses. 

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The Law Office of Jessica Taylor, PLLC

The Law Office of Jessica Taylor, PLLC
14100 San Pedro Avenue
Suite 602
San Antonio, TX 78232

Phone: 210-265-6759
Phone: (210) 402-4022
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