Billing > Billing

Late Filing Appeal

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redeyecherry:
Is there any use in appealing a claim, which was denied because of late filing, with office notes from that date?
The DOS was 5/9/08, it wasnt billed til 10/30/09! So it was late filed and we have no proof of timely filing. I work at a Doctors office and the office manager wants me to rebill it with office notice.

answers appreciated :)

blhoffman:
First you need to check the timely filing guidelines of the insurer. Look for any loopholes.
Is this Primary, Secondary or Teritary?
Then you need to contact the insurer and ask them to check in the patient's history on their system to find out when was the last time someone called about the date of service in question. (This information can be used in the appeal letter for reference.)
Verify the claim was never on file.

If the claim was never called about, not on file and truly untimely then there is nothing more you can do about it.

I also worked at an office that demanded we appeal everything. The idea was that the appeal is the final level and if denied then we have the backup for the write off. Do I agree with this method? No. Some situations do not call for an appeal but I do not argue with management. I do however make a note I am making the appeal at the request of said management.

medauthor:
This wasn't Medicare, right???  Because if so, you would have until 12/31/09 to file the claim...just checking  :)

Michele:
Appealing with the office notes for a timely filing denial is not going to help.  They are saying the claim wasn't submitted timely.  The appeal would either have to show proof that it was filed timely, or give a very good reason as to why it wasn't filed timely.

Michele

redeyecherry:
Thanks a bunch for the answers, just making sure i am not wrong in my assumption ;)

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