As an increasing number of insurance companies are providing chiropractic benefits to their subscribers, chiropractors are now submitting claims to insurance payers more regularly. When it comes to submitting chiropractic claims, late filing isn’t only unacceptable; it also causes denials.
If you’re confused by the timely filing limits and would like to know how to handle timely filing claim denials, check out these tips.
Timely Filing for Chiropractic Claims
We understand that chiropractic billing and coding are complex. There are so many things your biller needs to take care of when submitting a claim. Timely filing is one of them.
Timely filing pertains to the deadlines and/or limits set by insurance companies. To receive payment, providers must submit their claims within these designated timeframes.
For example, a patient visited your clinic on November 20th. They have an insurance company XYZ. Company XYZ has set its timely filing limit to 90 days “after the date of service.”
This means that you have 90 days from November 20th to submit the claim after the patient’s visit. In this example, the last day the insurance will accept the claim is February 21st.
Where can you find the timely filing for an insurance company?
Insurance companies publish comprehensive manuals known as provider manuals. These manuals contain a ton of information regarding their claim submission and reimbursement processes. If an insurance company has a defined timely filing limit, it’s located within their provider manual. Pay particular attention to their timely filing section.
Many insurances make their provider manuals available online. As an example, United Healthcare’s filing limit is 90 days after the date of service.
Do Insurances All Have The Same Deadlines?
No, different insurance companies have different timely filing limits for their chiropractic claim insurance submission. A quick analysis of the below insurance payers shows that the filing limit can range from 90 days to 180 days and even 24 months.
| Healthcare Insurance | Timely Filing Limit | Source |
| Aetna | 120 days from the date of service | Click here |
| Humana | 180 days (physicians), 90 days (ancillary providers) | Click here |
| BCBS MN | 120 days from the date of service | Click here |
| Medicare | 12 months from the date of service | Click here |
| Tricare | 12 months from the date of service | Click here |
| United Healthcare | 90 days from the date of service | Click here |
| Kaiser Permanente | 12 months after the date of service | Click here |
| Meridian | 365 days from the date of service | Click here |
| Emblem Health | 365 days (in-network), 18 months (out-of-network) | Click here |
How to handle timely filing claim denials
Claims are sometimes denied for timely filing when the claim was actually submitted on time but not received by the insurance payer. There are many reasons this can happen, but the important part of the equation is how you respond to the denial.
Other times, claims are denied for timely filing when they were not filed within the timely filing limit.
Chances are, you and your billing staff already have a ton of work to complete on a daily basis. Some of those responsibilities include scheduling, patient care, coding, and keeping track of payer requirements.
When a claim is denied due to timely filing issues, you must know how to handle them.
1. When a claim was submitted on time but denied
For example, you may have submitted a claim in the proper timeframe and it was denied for a reason such as an incorrect NPI number, or the patient’s name was misspelled, or it was originally sent to the wrong insurance payer.
Now, you should first understand why the claim was denied. Once you identify the problem, fix it. Resubmit the claim with the correct information. If the payer denies it for timely filing, the denial must be appealed by your biller.
Some insurance companies have special forms to appeal timely filing claim denials while others don’t use them. Whether you use their special form or create your own appeal form, you need to submit your proof of timely filing to that form.
When you use chiropractic billing software, you can find information showing the original submission date, and if the claim was submitted multiple times it should show each time submitted.
zHealth chiropractic software is integrated with a billing solution and clearinghouse. With zHealth, you can submit claims, track their statuses, view the original date billed, denial reasons, and how many times the claim was submitted in total. Reports generated from chiropractic practice management software cannot be altered and are accepted as proof by most insurance companies. Incorporating effective modifiers for chiropractic billing can further optimize reimbursement processes and minimize claim denials.
2. If the claim was not submitted in a given timeframe and denied
If the claim was not submitted in the timeframe allowed, then it is more difficult to appeal. If you have a valid reason for not submitting the claim on time, you can appeal based on that.
For instance, if the patient earlier informed you that he was not covered by his insurance company, but later on you found out that the payer actually covers your services. You submit the claim, but after the filing deadline is over. You can try to appeal the denial.
Lots of things can go wrong when you’re busy providing chiropractic services and managing your business. It is best to work out a system for handling claim denials for timely filing or hire professional chiropractic billing services.
Quick tips to submit accurate chiropractic claims
1. Mention the initial date of service in the claims
Do mention the initial date of service within a chiropractic insurance claim. This initial date of service is to identify the very first visit of the patient to your practice, in which you, as the chiropractor, provided diagnosis and treatment for the patient.
It is important to note that the “date of onset” and the “date of initial treatment” are not necessarily the same date.
2. Detailed documentation of the chiropractic services provided
Detailed documentation of the exact chiropractic treatments provided is essential for accurate chiropractic insurance claims. Check out our complete chiropractic billing guide on how to use ICD-10 codes, chiropractic CPT codes, modifiers, and other details when creating and submitting a claim.
3. Keep invoices and claims organized
In order to ensure that all of your claims are properly filed and submitted, it’s important to implement the best chiropractic software and keep your billing records up to date in the software. If you have a high claim volume, it’s important to hire professional billing specialists to manage your entire billing process. Billing experts can review your code, submit claims on time, file appeals, and manage claims denials and A/R.
Conclusion
Timely filing limits are only a small piece of the denial management landscape, understanding what they are, how to handle them, and prioritizing them will bring in more revenue.
Remember, it is important to file claims as quickly and timely as possible. If you have a good chiropractic billing software in place or billing specialists by your side, you will be able to handle claims efficiently and will eventually get paid faster.
Related Articles:
Claim Submission: 5 Steps to Getting It Right The First Time
Chiropractic Billing Services to Maximize Insurance Collections
Top 8 Free Chiropractic Medical Billing Resources
A Complete Guide to Chiropractic Billing and Coding
