The Most Common Denials:
Untimely Filing

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Health Plans are always finding ways to invent not paying a claim.  One of the most popular types of claims denials came as a result, and that is denying a claim that is untimely.  Most health plans have a defined time period on which to submit a health insurance claim and if the claim arrives beyond this date, the claim is denied.  A claim appeal is used to override this very common denial.   Some important things to know about Timely Filing Denials, include:  

  1. Health plans strictly abide by this rule, you or your physician/medical provider must make sure to submit a claim within the time frame allowed. 

  2. If your physician/medical provider does not properly submit a claim and they are "in-network" to your health plan, they may not bill you for their mistake.  The physician/medical provider must adjust the balance.

  3. All health plans have different timely filing requirements, it could be a minimum of 60 days to a maximum of 1 year.  Make sure you read your policy booklet to know which one applies to you.

  4. Sometimes a claim is submitted on time, but the health plan for some reason does not recognize it.  These should always be appealed.

  5. Usually when appealing a claim that was not submitted timely, it is best to provide some proof that it was billed timely.  Electronically submitted claims could use the print out of the electronic submission.  There is no such proof available for paper claims unless the medical providers sends them certified mail