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Appeals for Not Filing In Timely Manner

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dfranklin:
I recently signed up a new chiropractor and their previous billing company really screwed up their billings.  There were about 1000 claims that did not get filed.  I am filing all of these claims for them but my question is I am getting responses on the older ones that they are not paying them due to receiving the claim after the Timely Filing Limitation.  I was wondering if we could appeal this asking for an exception due to their circumstances.  Has anyone done this?  Any have suggestions on what to say in the letter or how to go about doing this?  There are quite a few so there is a good amount of money the doctor is losing on this.  Also since there are mulitple claims per carrier that are not paid for the timely filing reason can you appeal them together in one letter and submit the letter with multiple claims in the envelope or do you have to do one letter for each claim per envelope?

Thanks in advance for your help!

Priyan:
To be frank I havent tried for a claim which is not filed even once in past and now first filing denied for Untimely.

But, We can do it this way. We wouldnt have received rejections from Medicare, Medciaid and non par insurance as well as we have minimum of 1yr from dos. For medicare we have lot more by calender yr calculation.

For the contracted insurance companies, we can speak to our assigned provider relation representative as we had a system glitch that electronic claims did not go out of system. They will definetly Help us in getting atleast a 50-60% of avg after late filing reductions.

Again, this may work for us. Keep me adviced on the results or any different views

PMRNC:
It depends on HOW old. Medicare won't budge on timely filing denials. Some carriers you can appeal based on circumstances but make sure you include an appeal letter and again it depends on how old. If the carrier has to go to Microfiche..they don't like doing that it requires the examiner to get out of their chair.  :o

I've had success with timely filing appeals with a few carriers. If you get the patient or insured in on it you have a better chance. The carriers do have some sort of administrative decision making so it's not hopeless, just a bit difficult the older the claims are.

Michele:
We too have encountered similar situations.  If there is a provider rep that is the way we went.  Explained to them what happened, submitted all claims affected to their attention, and they got them all processed.  When the company didn't have a provider rep we would submit them with a cover letter explaining that the provider is unsure as to if the claims had been attempted to be submitted or not, and explained the situation where the provider had a biller/service that they had realized was not handling claims properly so they had called us in.  We would ask them to consider the claims even if they were past the filing limit since the provider was unaware of the situation.  Basically, it is still the provider's responsibility but some carriers did make the exception.

Michele

Michele:
When I used to work for a major insurance carrier I loved a reason to get out of my chair!  But most of my co workers didn't.  :(  Of course most of my job was fixing their mistakes!  LOL

Michele

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