Claims are denied by insurance companies daily for many different reasons. But one reason in particular, the Timely Filing Period denial, is certainly one that can and should be avoided at all costs. All insurance companies have a Timely Filing Period in regards to claims they receive must be received within a certain time period. The time period varies per insurance company and can be anywhere typically from 90 days to one year. Many state medicaid plans are 90 days, where as most traditional plans and PPOs are one year.
The most obvious and easiest way to avoid a Timely Filing denial is to make sure the insurance company receives the claim. Making sure the insurance has a claim sounds pretty simple, but in some cases, getting a claim to an insurance company is not so simple.
Unfortunately for most dentists, you have likely had Timely Filing denials. These continue to occur because of these 4 reasons:
- Clearinghouse Rejections
- Insurance Aging Reports Worked Inconsistently
- Multiple Claim Resubmissions
- No Follow Up
In sending electronic claims, you are utilizing a clearinghouse to get the claim from your software to the insurance company. The clearinghouse will not send claims to the insurance company if certain things are wrong with the claim; ie: DOB is incorrect, social security or ID number is incorrect, relationship status is incorrect, etc. These errors will show up in the clearinghouse and the claims need to be corrected in order for the insurance company to receive the claim.
Insurance Aging Reports Worked Inconsistently
As some dental practices have an insurance coordinator dedicated to posting insurance checks daily, others only have the tasks split amongst front desk and the office manager. The one duty that is often neglected is working the insurance aging report. This is a report that should be run and tracked by the dentist at least once per week. Someone in the office needs to be accountable for the insurance aging report. This means calling on claims daily and/or weekly instead of being overlooked. Inconsistent working of the insurance aging report is a recipe for Timely Filing denials.
Multiple Claim Resubmissions
There is a difference between working the insurance aging report and just resubmitting claims.
One dentist I worked with told me her insurance coordinator worked the aging report every week and had 0 claims over 30 days. Collections were still down so I pulled the 30 day report.. No claims. I then pulled the 0 day report, and it was extensive. What I found was the insurance coordinator was resubmitting all the claims 5 and 6 times. One even got resubmitted 9 times. With the software she had, every time the claim was resubmitted, the tracking went back to 0 days. Any claim over 30 days would just be resubmitted and removed from the report before the report was given to the dentist.
As you can see from my previous experience, claims being resubmitted 5 or 6 times, or even 9 times, is not going to get claims paid. Without doing the research on why the claim is being denied, submitting the same exact claim will just get denied 5 or 6 times, or even 9 times. I always say “there’s a difference in working the insurance aging report and actually WORKING the insurance aging report.” And by this I mean, actually doing the research to find out why the claim was denied, correcting the issue, and getting the claim properly to the insurance company in a timely manner thus avoiding any Timely Filing denials.
No Follow Up
Timely Filings will certainly occur if there is No Follow Up. Having No Follow Up is the biggest mistake dental offices continue to make. It may be common knowledge that someone needs to be following up on your insurance aging report, but this continues to happen across the board in many dental practices today. The dentists, the office managers, the business owners need to hold someone accountable for diligently working the insurance aging reports. Without someone dedicated to this job, you will in fact have Timely Filing denials occurring regularly within your practice.
Davy Clay, MBA, CDC