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

#denialmanagement
#medicalbilling
#dminmb

Here is the raw data notes

The time limit for claim filing has expired

As denial reason states:
Most of the insurance will set a specific timely filing limit to submit claims. If claim is filed after timely filed limit. It will be denied stating timely filing limit expired.

If claims timely filing limit is 180 days from dos. then claims must be submitted with in timely filing limit from DOS.
claims tfl varies from ins to ins.
tfl depends on provider contract also. Usually in network provider has less tfl than out of network provider.

We'll see the example of this scenario

We know that Medicare claims timely filing limit 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 filed claim to medicare on 01/02/2021 which was received by payor on 1/3/2021.

That is after 1 year from dos so It will be denied as crossed timely filing limit.

now how to follow up on this claim?

If claim is denied as crossed timely filing limit
first We need to verify, What is the timely filing limit to submit the claim.
second verify claim received date.
If claim is submitted within tfl we need to call insurance and request representative to reprocess the claim as it was received by payor within claims time filing limit.
if claim was submitted after timely filing limit. We need to check if we have any proof of timely filing limit.

now what is proof of timely filing limit

it is document or evidence that supports the reason why this claim was submitted after timely filing limit.

Let's understand this with example.

For iif patient has 2 ins active on dos 4/1/2020. primary insurance claims tfl is 60 days from dos that is till 5/30/2020 and we see that claim was filed to secondary on 5/15/2020 in error. however, Secondary ins recieved claim on 5/20/2020 and was denied stating other insurance is primary on 5/28/2020. later someone verified and claim filed to primary insurance 6/2/2020 which was dnd as claim filed after timely limit.

Here we have secondary insurance denial EOB as proof of timely filing.

In this case we need to submit appeal with potfl to primary insurance.
stating "claim was initially submitted to secondary ins in error. We have attached proof of tfl.
Kindly review and reprocess the claim accordingly."
If proof of tfl is valid, insurance will reprocess the claim.
If there is no POTF, provider need to adjust the claim as there is no proof of tfl
Sometimes, If billed amount is higher. As per provider request we may need to send an courtesy appeal to payor requesting to reconsider, as this claim has higher dollar value.

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

DOS 4/1/2020. upon check found claim was initially submitted to secondary on 5/15/20 which was denied as primary eob needed on 5/28/20. claim filed to primary on 6/2/20. so called ins @ 8008008000 and sw representative said claim received on 6/3/20 and it was denied on 6/4/20 as timely filing limit exceeded. claims tfl is 60 days from dos. appeal mailing address is po box 1234 salt city UT 12345. Appeal tfl is 120 days from denial date. call ref# 1234. hence sent appeal with POTF.

[santoshkumarm]

Your explanation is good. Why can't you make try to more some videos

[PraharshMishra-rp]

Please help with this scenario . Molina marketplace partial paid the claim and denied the 1 cpt then we submit the claim after CCFL but they recoupt the all amount which is already paid and denied as timely filling limit, so how to solve this problem? Please help

[vimalsharma]

Please make a video on CO29 denial code. what is the reason and it's resolution?

[ramyakrishna]

Please do a video on CO-16 and CO-46 please do for god sake

[nipunkalinga]

what if both denial code n286 and 29 are there ? which one to address ?

[BARATHM-mizp]

Hi bro can you please explain all the POS(Please of Services) in medical billing

[RohitSharma_]

If primary insurance denied as past TFL. Can we bill the claim to secondary?

[rizwan]

Suppose if claim denied for past tfl we filed claim after the tfl nd we don't have any proof of tfl.. can we take chances for appeal for payment if so then what exact comments..if you can provide comments it will be helpful for me

[himanshusrivastava]

Hi sir,
I have some doubt on Pre existing condition denial.
Could you please make video on pre existing condition denial?

[merimarji_thinkbeforethink]

Please don't add background music