Top

The Timely Filing Limit: A Comprehensive Guide

TheUltimateGuidetoTimelyFilingLimits_22019

Almost 100 years ago, Maynard Keynes stated that we’d only have to work around three hours a day, and only by choice.

That might seem like a completely ridiculous statement in the modern day, but back then working hours became considerably shorter due to economic progress and technological advances so he had a good reason to think it that momentum would continue.

His prediction was little off, given that I am at the beginning of my eight hour work day as I’m writing this piece. However, he was right about technology’s effect on our productivity.

We can now fit multiple different tasks within our work days that we wouldn’t have been able to do in the past, this is especially true within the medical billing space.

In medical billing, time is extremely important because when it comes to claim submissions there is some serious revenue on the line. A timely filing limit is a constant, lingering due date that healthcare providers need to understand.

Timely Filing Limits

What is a timely filing limit?

Every medical biller is familiar with timely filing limits. If you aren’t, they are a time frame set by each individual insurance company in which a practice or other healthcare company needs to submit their insurance claims.

For example, let’s say a patient visited a doctor’s office on February 20th and the patient has health insurance company ABC. Company ABC has set a timely filing limit to 90 days after the service was rendered.

This means the doctor’s office has 90 days from February 18th to submit that patient’s health insurance claim. In this example, the doctor’s office timely filing deadline would be May 21th.

Why are there timely filing limits?

It may seem unfair that insurance companies place timely filing limits on claims but it ensures that they are sent as soon as possible.

These timely filing limits make it easier for doctors to receive their money and insurance companies to process claims in a (you guessed it) timely manner.

If you look at the terms of any healthcare insurance company, they will almost always have a clause located somewhere within their document that indicates that the payer isn’t responsible for claims they receive outside of their set timely filing limit.

Since insurance companies are legally not responsible, if you send in a claim after the timely filing limit, it will be denied and you will more than likely be forced to write it off.

 
 

How are timely filing limits hard?

90 days is plenty of time to submit claims for healthcare organizations because they realize that revenue is on the line and will do anything to get paid as quickly as possible, right?

Well, submitting the claim isn’t the hard part when it comes to timely filing. The biggest challenge is that there is no set standard among healthcare insurance companies for their timely filing limit.

Generally, a timely filing limit is no less than 90 days but they can sometimes range to 15 months or more. Below we’ve listed some of the biggest healthcare insurance providers, their respective timely filing limit, and the documentation it was sourced from.

Healthcare Insurance Timely Filing Limit Source
Aetna 120 days from the date of service Click here
Humana 180 days (physicians), 90 days (ancillary providers) Click here
Medicare 12 months from the date of service Click here
Tricare 12 months from the date of service Click here
United Healthcare 90 days from the date of service Click here
Kaiser Permanente 12 months after the date of service Click here
Medical Mutual 12 months from the date of service Click here
Emblem Health 365 days (in-network), 18 months (out-of-network) Click here
 
 

As a healthcare organization, your staff already has a ton of work to do including caring for patients, coding, and keeping track of contracted requirements.

On top of those tasks, your workforce needs to submit patient claims within their timely filing limits.

If your team isn’t familiar with all insurance companys’ timely filing limits then the chances that they will submit their claim late increases dramatically.

If you submit a claim past its timely filing due date then it will be sent back as one of the most common types of denials: CARC 29 - exceeded timely filing.

CARC 29 has a high chance of prevention but a low overturn rate. Essentially this means that it has a low chance of being appealed, thus you lose money.

“I submitted my claim on time and there were no mistakes but I still received CARC 29. What gives?”

Sometimes you’ll receive CARC 29 even though the claim information was correct and you sent it in on time within that insurance providers timely filing limit.

It is possible that the insurance provider lost or never received the claim you sent due to an error.

If you ever find yourself in that situation, your clearinghouse should offer what’s called a timely filing report, this report should list the date your claim was submitted to the clearinghouse and the payer.