REJECTION REASON [CO 29] - TIMELY FILING LIMIT EXCEEDED [rejection management] in medical billing

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#dminmb

Here is the raw information notes

The time limitation for claim filing has actually ended

As rejection factor states:
The majority of the insurance coverage will set a particular prompt filing limitation to send claims. If claim is submitted after prompt submitted limitation. It will be rejected mentioning prompt filing limitation ended.

If claims prompt filing limitation is 180 days from dos. Claims need to be sent with in prompt filing limitation from DOS.
claims tfl differs from ins to ins.
Tfl depends on company agreement. Typically in network company has less tfl than out of network supplier.

We’ll see the example of this circumstance

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

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

now how to act on this claim?

If claim is rejected as crossed prompt filing limitation
We require to validate, What is the prompt filing limitation to send the claim.
2nd confirm claim got date.
If claim is sent within tfl we require to call insurance coverage and demand agent to recycle the claim as it was gotten by payor within claims time submitting limitation.
if claim was sent after prompt filing limitation. We require to inspect 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 reason 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 insurance coverage 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. Secondary ins recieved claim on 5/20/2020 and was rejected specifying other insurance coverage is main on 5/28/2020. later on somebody confirmed and claim submitted to main insurance coverage 6/2/2020 which was dnd as claim submitted after prompt limitation.

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

In this case we require to send appeal with potfl to main insurance coverage.
specifying “claim was at first sent to secondary ins in mistake. We have actually connected evidence of tfl.
Kindly evaluation and recycle the claim appropriately.”
If evidence of tfl stands, insurance coverage will recycle the claim.
If there is no POTF, company requirement to change the claim as there is no evidence of tfl
Often, If billed quantity is greater. Based on service provider demand we might require to send out an courtesy interest payor asking for to reassess, 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 at first 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. Called ins @ 8008008000 and sw agent stated claim gotten on 6/3/20 and it was rejected on 6/4/20 as prompt filing limitation surpassed. claims tfl is 60 days from dos. appeal mailing address is po box 1234 salt city UT 12345. Appeal tfl is 120 days from rejection date. call ref # 1234. Sent out appeal with POTF.

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