Text Wrangling: Timely Filing Limits

medical-billing medical-coding data-analytics

Coding a more intuitive framework for a Timely Filing Limits table from external sources for internal use.

Andrew Bruce https://andrewbruce.netlify.app
2022-06-26

Introduction

The Timely Filing Limit is the time frame set by health insurance companies indicating the number of days after the Date of Service (DOS) a provider has to submit a claim before reimbursement of the claim can be contractually denied. Claims submitted after the timely limit will be denied with the CARC (Claim Adjustment Reason Code) CO-29: The time limit for filing has expired. For many major insurance companies, including Medicare and Medicaid, the filing limit is one year from the DOS. If the provider is contracted or in-network, the timely filing limit can be much shorter as specified in the contractual agreement.

There should seldom be a time when claims are filed outside the filing limit. The only exceptions might be when you are dealing with a Medicare secondary and were appealing a denial prior to submitting to the secondary, or when an account was sent to work comp, then after much review was denied as not liable and now must be billed to health insurance. In these cases, you can appeal the claims, but you must call the insurance company and see what their appeal rights are. Medicare and Medicaid have specific appeal guidelines in their provider manuals, but other insurance companies vary.

If you actually were outside the timely filing limit, many insurance companies and most provider agreements prohibit you from pursuing the patient for the denied balance. It is also poor consumer relations to make the patient pay for your office’s failure to submit the claim.

Rebills on Claims Filed Timely

A frustrating problem when doing account follow-up is that most insurance companies only hold or “pend” claims in their system for 60 to 90 days. After that, if they are not paid or denied, they are deleted from their computers. A large insurance company may receive over 100,000 claims a day and their systems cannot hold that volume of pending claims. When you call to follow up, they will state, “we have no record in our system of having received that claim.”

Now your only recourse is to rebill the claim. If it is outside their “timely filing”, you will get a denial back. You should and must now appeal the denial. The first thing that you will need is proof that you actually did file the claim within the time window allowed.

Review the application to find out the date of first submission. If the first submission was after the filing limit, adjust the balance as per client instructions. If claim history states the claim was submitted to wrong insurance or submitted to the correct insurance but not received, appeal the claim with screen shots of submission as proof of timely filing(POTF) and copy of clearing house acknowledgement report can also be used. If we have clearing house acknowledgement date, we can try and reprocess the claim over a call. If previous notes states, appeal is already sent. Reach out insurance for appeal status.

Proof of Timely Filing

For paper claims, you can reprint and attach the original claim, however some billing software will put today’s date on the reprinted claim. Ask your software provider to walk you through reprinting a claim with the original date. There is no reason to photocopy all claims just in case you need to prove timely filing. For electronic claims, you should have the claims submittal report from your clearinghouse. These should always be kept (in electronic format) on your computer by date in a folder that is regularly backed-up.

Packages

library(tidyverse)
library(tidytable)
library(rmarkdown)
library(lubridate)
library(htmltools)

Data

I’ll use the {datapasta} package and it’s vector_paste_vertical() function to copy the table from this website and paste it into R as a vector, which gives us this character vector:

tfl_vec <- c(
  "AARP\t15 Month from Date of Service (DOS)",
  "Advantage Care\t6 Month",
  "Advantage Freedom\t2 Years from DOS",
  "Aetna\t120 Days from DOS",
  "Ameri health ADM Local 360\t1 Year from DOS",
  "American Life and Health\t12 Month",
  "American Progressive\t1 Year",
  "Amerigroup\t90 Days for Participating Providers/12 Months for Non-PAR Providers",
  "Amerihealth ADM TPA\t1 Year",
  "AmeriHealth NJ & DE\t60 Days",
  "AMA\t2 Years from DOS",
  "Anthem Health(Coast wise Claims)\t3 Years from DOS",
  "Arbazo\t180 Days",
  "Bankers Life\t15 Month from DOS",
  "BCBS\t180 Days from Initial Claims or if its secondary 60 Days from Primary EOB",
  "Benefit Concepts\t12 Month from DOS",
  "BCBS COVERKIDS\t120 Days from DOS",
  "BCBS Florida timely filing\t12 Month from DOS",
  "BeechStreet\t90 Days from DOS",
  "Benefit Trust Fund\t1 year from Medicare EOB",
  "Blue Advantage HMO\t180 Days from DOS",
  "Blue Cross PPO\t1 Year from DOS",
  "Blue Essential\t180 Days from DOS",
  "Blue Premier\t180 Days from DOS",
  "Blue Shield timely filing\t1 Year from DOS",
  "Blue shield High Mark\t60 Days from DOS",
  "Bridgestone/Firestone\t12/31 of the following year of the service",
  "Cigna timely filing limit\t90 Days for Participating Providers/180 Days for Non-par Providers",
  "Cigna HealthSprings (Medicare Plans)\t120 Days",
  "Champus\t1 Year from DOS",
  "Citrus\t1 Year from DOS",
  "Coventry\t180 Days from DOS",
  "Evercare\t60 Days from DOS",
  "First Health\t3 Month from DOS",
  "Fire Fighter/Local 1014\t15 Month from DOS",
  "FRA\t15 Month from DOS",
  "FMH\t6 Month from DOS",
  "GHI- Group health Ins\t1 Year from DOS",
  "Great West (AH&L)\t90 Days from DOS",
  "Healthcare Partners\t90 Days from DOS",
  "Healthnet HMO\t90 Days from DOS",
  "Healthnet PPO\t120 Days from DOS",
  "Horizon NJ Plus\t365 Days from DOS",
  "Humana\t180 Days for Physicians or 90 Days for facilities or ancillary providers",
  "Humana\t27 Month from DOS",
  "ILWU\t3 Years from DOS",
  "Keystone Health Plan East\t60 Days from DOS",
  "Local 831 Health\t1 year from DOS",
  "Magna Care\t6 Month from DOS",
  "Motion Picture Ind\t15 Month from DOS",
  "Marilyn Electro IND. Benefit Fund\t1 Year from DOS",
  "Medicaid\t95 Days from DOS",
  "Medicare timely filing limit\t1 Year from DOS",
  "Mega Life and Health\t15 Month from DOS",
  "Memorial IPA\t90 Days from DOS",
  "Monarch IPA\t90 Days from DOS",
  "Mutual of Omaha\t1 year from DOS",
  "Nationwide Health\t15 Month from DOS",
  "NASI\t2 Years from DOS",
  "Omnicare IPA\t90 Days from DOS",
  "One Healthplan\t15 Month from DOS",
  "Operating Engineers\t1 Year from DOS",
  "Pacificare PPO\t90 Days from DOS",
  "Pioneer Medical Group\t60 Days from DOS",
  "Polk Community Health Care\t180 Days from DOS",
  "Prospect Medical Group\t90 Days from DOS",
  "Principle Financial\t3 Years from DOS",
  "PUP\t180 Days from DOS",
  "Quality Health Plan\t1 Year from DOS",
  "SMA\t1 year from DOS",
  "So. Ca Drug Benefit\t1 year from DOS",
  "Secure Hoizons\t90 Days from DOS",
  "Sun\t180 Days from DOS",
  "Tricare\t12 Month from DOS",
  "Troa/mediplus\t2 year from DOS",
  "UFCW\t1 year from DOS",
  "UHC Community\t120 Days from DOS",
  "Union Fidelity\t1 Year from DOS",
  "Unicare\t24 Month from DOS",
  "UHC COMMERCIAL\t90 Days from DOS",
  "United Teacher Associates\t15 Month from DOS",
  "Veterans Admin\t90 Days from DOS",
  "Vista\t120 Days from DOS",
  "Wellcare\t180 Days from DOS",
  "Writers Guild Health\t18 Month from DOS",
  "Zenith\t1 Year from DOS"
)

str(tfl_vec)
 chr [1:86] "AARP\t15 Month from Date of Service (DOS)" "Advantage Care\t6 Month" "Advantage Freedom\t2 Years from DOS" "Aetna\t120 Days from DOS" "Ameri health ADM Local 360\t1 Year from DOS" ...
names(tfl_vec) <- "column"

str(tfl_vec)
 Named chr [1:86] "AARP\t15 Month from Date of Service (DOS)" "Advantage Care\t6 Month" "Advantage Freedom\t2 Years from DOS" "Aetna\t120 Days from DOS" ...
 - attr(*, "names")= chr [1:86] "column" NA NA NA ...
tfl_vec <- data.frame(as.list(tfl_vec))

glimpse(tfl_vec)
Rows: 1
Columns: 86
$ column <chr> "AARP\t15 Month from Date of Service (DOS)"
$ NA.    <chr> "Advantage Care\t6 Month"
$ NA..1  <chr> "Advantage Freedom\t2 Years from DOS"
$ NA..2  <chr> "Aetna\t120 Days from DOS"
$ NA..3  <chr> "Ameri health ADM Local 360\t1 Year from DOS"
$ NA..4  <chr> "American Life and Health\t12 Month"
$ NA..5  <chr> "American Progressive\t1 Year"
$ NA..6  <chr> "Amerigroup\t90 Days for Participating Providers/12 Months for Non-PAR Providers"
$ NA..7  <chr> "Amerihealth ADM TPA\t1 Year"
$ NA..8  <chr> "AmeriHealth NJ & DE\t60 Days"
$ NA..9  <chr> "AMA\t2 Years from DOS"
$ NA..10 <chr> "Anthem Health(Coast wise Claims)\t3 Years from DOS"
$ NA..11 <chr> "Arbazo\t180 Days"
$ NA..12 <chr> "Bankers Life\t15 Month from DOS"
$ NA..13 <chr> "BCBS\t180 Days from Initial Claims or if its secondary 60 Days from Primary EOB"
$ NA..14 <chr> "Benefit Concepts\t12 Month from DOS"
$ NA..15 <chr> "BCBS COVERKIDS\t120 Days from DOS"
$ NA..16 <chr> "BCBS Florida timely filing\t12 Month from DOS"
$ NA..17 <chr> "BeechStreet\t90 Days from DOS"
$ NA..18 <chr> "Benefit Trust Fund\t1 year from Medicare EOB"
$ NA..19 <chr> "Blue Advantage HMO\t180 Days from DOS"
$ NA..20 <chr> "Blue Cross PPO\t1 Year from DOS"
$ NA..21 <chr> "Blue Essential\t180 Days from DOS"
$ NA..22 <chr> "Blue Premier\t180 Days from DOS"
$ NA..23 <chr> "Blue Shield timely filing\t1 Year from DOS"
$ NA..24 <chr> "Blue shield High Mark\t60 Days from DOS"
$ NA..25 <chr> "Bridgestone/Firestone\t12/31 of the following year of the service"
$ NA..26 <chr> "Cigna timely filing limit\t90 Days for Participating Providers/180 Days for Non-par Providers"
$ NA..27 <chr> "Cigna HealthSprings (Medicare Plans)\t120 Days"
$ NA..28 <chr> "Champus\t1 Year from DOS"
$ NA..29 <chr> "Citrus\t1 Year from DOS"
$ NA..30 <chr> "Coventry\t180 Days from DOS"
$ NA..31 <chr> "Evercare\t60 Days from DOS"
$ NA..32 <chr> "First Health\t3 Month from DOS"
$ NA..33 <chr> "Fire Fighter/Local 1014\t15 Month from DOS"
$ NA..34 <chr> "FRA\t15 Month from DOS"
$ NA..35 <chr> "FMH\t6 Month from DOS"
$ NA..36 <chr> "GHI- Group health Ins\t1 Year from DOS"
$ NA..37 <chr> "Great West (AH&L)\t90 Days from DOS"
$ NA..38 <chr> "Healthcare Partners\t90 Days from DOS"
$ NA..39 <chr> "Healthnet HMO\t90 Days from DOS"
$ NA..40 <chr> "Healthnet PPO\t120 Days from DOS"
$ NA..41 <chr> "Horizon NJ Plus\t365 Days from DOS"
$ NA..42 <chr> "Humana\t180 Days for Physicians or 90 Days for facilities or ancillary providers"
$ NA..43 <chr> "Humana\t27 Month from DOS"
$ NA..44 <chr> "ILWU\t3 Years from DOS"
$ NA..45 <chr> "Keystone Health Plan East\t60 Days from DOS"
$ NA..46 <chr> "Local 831 Health\t1 year from DOS"
$ NA..47 <chr> "Magna Care\t6 Month from DOS"
$ NA..48 <chr> "Motion Picture Ind\t15 Month from DOS"
$ NA..49 <chr> "Marilyn Electro IND. Benefit Fund\t1 Year from DOS"
$ NA..50 <chr> "Medicaid\t95 Days from DOS"
$ NA..51 <chr> "Medicare timely filing limit\t1 Year from DOS"
$ NA..52 <chr> "Mega Life and Health\t15 Month from DOS"
$ NA..53 <chr> "Memorial IPA\t90 Days from DOS"
$ NA..54 <chr> "Monarch IPA\t90 Days from DOS"
$ NA..55 <chr> "Mutual of Omaha\t1 year from DOS"
$ NA..56 <chr> "Nationwide Health\t15 Month from DOS"
$ NA..57 <chr> "NASI\t2 Years from DOS"
$ NA..58 <chr> "Omnicare IPA\t90 Days from DOS"
$ NA..59 <chr> "One Healthplan\t15 Month from DOS"
$ NA..60 <chr> "Operating Engineers\t1 Year from DOS"
$ NA..61 <chr> "Pacificare PPO\t90 Days from DOS"
$ NA..62 <chr> "Pioneer Medical Group\t60 Days from DOS"
$ NA..63 <chr> "Polk Community Health Care\t180 Days from DOS"
$ NA..64 <chr> "Prospect Medical Group\t90 Days from DOS"
$ NA..65 <chr> "Principle Financial\t3 Years from DOS"
$ NA..66 <chr> "PUP\t180 Days from DOS"
$ NA..67 <chr> "Quality Health Plan\t1 Year from DOS"
$ NA..68 <chr> "SMA\t1 year from DOS"
$ NA..69 <chr> "So. Ca Drug Benefit\t1 year from DOS"
$ NA..70 <chr> "Secure Hoizons\t90 Days from DOS"
$ NA..71 <chr> "Sun\t180 Days from DOS"
$ NA..72 <chr> "Tricare\t12 Month from DOS"
$ NA..73 <chr> "Troa/mediplus\t2 year from DOS"
$ NA..74 <chr> "UFCW\t1 year from DOS"
$ NA..75 <chr> "UHC Community\t120 Days from DOS"
$ NA..76 <chr> "Union Fidelity\t1 Year from DOS"
$ NA..77 <chr> "Unicare\t24 Month from DOS"
$ NA..78 <chr> "UHC COMMERCIAL\t90 Days from DOS"
$ NA..79 <chr> "United Teacher Associates\t15 Month from DOS"
$ NA..80 <chr> "Veterans Admin\t90 Days from DOS"
$ NA..81 <chr> "Vista\t120 Days from DOS"
$ NA..82 <chr> "Wellcare\t180 Days from DOS"
$ NA..83 <chr> "Writers Guild Health\t18 Month from DOS"
$ NA..84 <chr> "Zenith\t1 Year from DOS"
tfl_vec <- tfl_vec |>
  tidyr::pivot_longer(
    everything(),
    names_to = "remove",
    values_to = "insurance"
  )

tfl_vec
# A tibble: 86 × 2
   remove insurance                                                                        
   <chr>  <chr>                                                                            
 1 column "AARP\t15 Month from Date of Service (DOS)"                                      
 2 NA.    "Advantage Care\t6 Month"                                                        
 3 NA..1  "Advantage Freedom\t2 Years from DOS"                                            
 4 NA..2  "Aetna\t120 Days from DOS"                                                       
 5 NA..3  "Ameri health ADM Local 360\t1 Year from DOS"                                    
 6 NA..4  "American Life and Health\t12 Month"                                             
 7 NA..5  "American Progressive\t1 Year"                                                   
 8 NA..6  "Amerigroup\t90 Days for Participating Providers/12 Months for Non-PAR Providers"
 9 NA..7  "Amerihealth ADM TPA\t1 Year"                                                    
10 NA..8  "AmeriHealth NJ & DE\t60 Days"                                                   
# … with 76 more rows
tfl_vec <- tfl_vec |>
  mutate(
    company = ifelse(
      str_detect(
        insurance,
        "\t"
      ),
      str_match(
        insurance,
        "(.*)\t"
      )[, 2],
      insurance
    ),
    limit = str_match(
      insurance,
      "\t(.*)"
    )[, 2]
  ) |>
  select(
    company,
    limit
  )

tfl_vec
# A tibble: 86 × 2
   company                    limit                                                              
   <chr>                      <chr>                                                              
 1 AARP                       15 Month from Date of Service (DOS)                                
 2 Advantage Care             6 Month                                                            
 3 Advantage Freedom          2 Years from DOS                                                   
 4 Aetna                      120 Days from DOS                                                  
 5 Ameri health ADM Local 360 1 Year from DOS                                                    
 6 American Life and Health   12 Month                                                           
 7 American Progressive       1 Year                                                             
 8 Amerigroup                 90 Days for Participating Providers/12 Months for Non-PAR Providers
 9 Amerihealth ADM TPA        1 Year                                                             
10 AmeriHealth NJ & DE        60 Days                                                            
# … with 76 more rows

Citations

Package Version Citation
base 4.2.0 R Core Team (2022)
distill 1.4 Dervieux et al. (2022)
grateful 0.1.11 Rodríguez-Sánchez, Jackson, and Hutchins (2022)
htmltools 0.5.2 Cheng et al. (2021)
knitr 1.39 Xie (2014); Xie (2015); Xie (2022)
rmarkdown 2.14 Xie, Allaire, and Grolemund (2018); Xie, Dervieux, and Riederer (2020); Allaire et al. (2022)
sessioninfo 1.2.2 Wickham et al. (2021)
tidytable 0.8.0 Fairbanks (2022)
tidyverse 1.3.1 Wickham et al. (2019)
xaringanExtra 0.6.0 Aden-Buie and Warkentin (2022)

Last updated on

[1] "2022-06-26 01:13:14 EDT"

Session Info

sessioninfo::session_info()
─ Session info ───────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────
 setting  value
 version  R version 4.2.0 (2022-04-22 ucrt)
 os       Windows 10 x64 (build 25145)
 system   x86_64, mingw32
 ui       RTerm
 language (EN)
 collate  English_United States.utf8
 ctype    English_United States.utf8
 tz       America/New_York
 date     2022-06-26
 pandoc   2.17.1.1 @ C:/Program Files/RStudio/bin/quarto/bin/ (via rmarkdown)

─ Packages ───────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────
 package       * version date (UTC) lib source
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 [1] C:/Users/andyb/AppData/Local/R/win-library/4.2
 [2] C:/Program Files/R/R-4.2.0/library

──────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────
Aden-Buie, Garrick, and Matthew T. Warkentin. 2022. xaringanExtra: Extras and Extensions for ’Xaringan’ Slides. https://CRAN.R-project.org/package=xaringanExtra.
Allaire, JJ, Yihui Xie, Jonathan McPherson, Javier Luraschi, Kevin Ushey, Aron Atkins, Hadley Wickham, Joe Cheng, Winston Chang, and Richard Iannone. 2022. Rmarkdown: Dynamic Documents for r. https://github.com/rstudio/rmarkdown.
Cheng, Joe, Carson Sievert, Barret Schloerke, Winston Chang, Yihui Xie, and Jeff Allen. 2021. Htmltools: Tools for HTML. https://CRAN.R-project.org/package=htmltools.
Dervieux, Christophe, JJ Allaire, Rich Iannone, Alison Presmanes Hill, and Yihui Xie. 2022. Distill: ’R Markdown’ Format for Scientific and Technical Writing. https://CRAN.R-project.org/package=distill.
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Text and figures are licensed under Creative Commons Attribution CC BY 4.0. Source code is available at https://github.com/andrewallenbruce, unless otherwise noted. The figures that have been reused from other sources don't fall under this license and can be recognized by a note in their caption: "Figure from ...".

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Bruce (2022, June 26). Andrew Bruce: Text Wrangling: Timely Filing Limits. Retrieved from https://andrewbruce.netlify.app/posts/text-wrangling-timely-filing-limits/

BibTeX citation

@misc{bruce2022text,
  author = {Bruce, Andrew},
  title = {Andrew Bruce: Text Wrangling: Timely Filing Limits},
  url = {https://andrewbruce.netlify.app/posts/text-wrangling-timely-filing-limits/},
  year = {2022}
}

Andrew A. Bruce - - made with , and {distill}