DENIAL REASON [CO 29] - TIMELY FILING LIMIT EXCEEDED [denial management] in medical billing

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#medicalbilling
#dminmb

Here is the raw information notes

The time limitation for claim filing has ended

As rejection factor states:
Most of the insurancecoverage will set a particular prompt filing limitation to send claims. If claim is submitted after prompt submitted limitation. It will be rejected specifying prompt filing limitation ended.

If declares prompt filing limitation is 180 days from dos. then declares should be sent with in prompt filing limitation from DOS.
declares tfl differs from ins to ins.
tfl depends on supplier agreement . Usually in network serviceprovider has less tfl than out of network company.

We’ll see the example of this situation

We understand that Medicare claims prompt filing limitation is 1 year from date of service.
now our Date of service is 01/01/2020 declares tfl ends on 12/31/2020 and we haveactually submitted claim to medicare on 01/02/2021 which was got by payor on 1/3/2021.

That is after 1 year from dos so It will be rejected as crossed prompt filing limitation.

now how to follow up on this claim?

If claim is rejected as crossed prompt filing limitation
initially We requirement to confirm, What is the prompt filing limitation to send the claim.
2nd validate claim got date.
If claim is sent within tfl we requirement to call insurancecoverage and demand agent to recycle the claim as it was got by payor within declares time filing limitation.
if claim was sent after prompt filing limitation. We requirement to check if we have any evidence of prompt filing limitation.

now what is evidence of prompt filing limitation

it is file or proof that supports the factor why this claim was sent after prompt filing limitation.

Let’s comprehend this with example.

For iif client has 2 ins active on dos 4/1/2020. main insurancecoverage declares tfl is 60 days from dos that is till 5/30/2020 and we see that claim was submitted to secondary on 5/15/2020 in mistake. nevertheless, Secondary ins recieved claim on 5/20/2020 and was rejected specifying other insurancecoverage is main on 5/28/2020. lateron somebody validated and claim submitted to main insurancecoverage 6/2/2020 which was dnd as claim submitted after prompt limitation.

Here we have secondary insurancecoverage rejection EOB as evidence of prompt filing.

In this case we requirement to send appeal with potfl to main insurancecoverage.
specifying “claim was atfirst sent to secondary ins in mistake. We haveactually connected evidence of tfl.
Kindly evaluation and recycle the claim appropriately.”
If evidence of tfl is legitimate, insurancecoverage will recycle the claim.
If there is no POTF, company requirement to change the claim as there is no evidence of tfl
Sometimes, If billed quantity is greater. As per company demand we might requirement to sendout an courtesy appeal to payor askingfor to reevaluate, as this claim has greater dollar worth.

here is the Notes if we have evidence of tfl.
pre call analysis notes:
on call:
post call action:

DOS 4/1/2020. upon check discovered claim was atfirst sent to secondary on 5/15/20 which was rejected as main eob required on 5/28/20. claim submitted to main on 6/2/20. so called ins @ 8008008000 and sw agent stated claim got on 6/3/20 and it was rejected on 6/4/20 as prompt filing limitation wentbeyond. declares tfl is 60 days from dos. appeal mailing address is po box 1234 salt city UT12345 Appeal tfl is 120 days from rejection date. call ref#1234 thus sentout appeal with POTF.

http://medicalbillingcertificationprograms.org/denial-reason-co-29-timely-filing-limit-exceeded-denial-management-in-medical-billing/