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Punitive Filing Deadlines

Providers of healthcare services should be outraged by timely filing limits placed in many commercial payer and physician hospital organization contracts. Yet filing limits are rarely examined or negotiated. The carriers have punished many providers by setting claim filing deadlines that are unnecessarily restrictive. Some of these carriers go so far as to provide ID cards that specify incorrect claim centers. They allow a limited window to get a claim paid; however, they believe they have an unlimited amount of time to extract refunds, yet you cannot back bill. Many carriers contract with outside firms to mine several years worth of data for potential refunds. We have fought off many attempts by carriers to request these types of refunds.

While the vast majority of all claims are submitted and paid in less than 30 days, certain claims are delayed by patients or the provider of service. A simple example is when a patient presents their old insurance ID card and then fails to respond to requests for updated information. After the filing limit, the patient provides the correct policy information and the claim is denied. While we have had success enlisting the patient’s assistance to get these claim decisions reversed, the process is cumbersome and the outcome is not guaranteed.