Timely Filing Appeal Letter Template
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Running a mental health practice requires therapists to have both clinical knowledge and business acumen. On the business side, you’ll want to learn how to effectively manage billing and payments, collect unpaid balances, understand insurance billing, and create a timely filing appeal letter in case of late claims filing.
This article provides a comprehensive overview of appealing timely filing denials, and we’ve included a free, downloadable timely filing appeal letter template that you can customize for your practice—saving you time that you can spend on the people and activities that are most important to you.
What is timely filing?
Whether you handle claims personally or use a medical biller, you’ll need to ensure claims are filed in a timely manner.
Insurance companies specify what they consider to be a reasonable timeframe—known as a timely filing period—for providers to submit a claim for their services.
However, each insurer is different when it comes to their timely filing deadlines, so you will need to check their website for details.
For example:
- Medicare claims must be filed no later than 12 months from the service date.
- Medicaid also requires claims to be received within 365 days of the date of service.
- BlueCross BlueShield of Minnesota requires claims to be submitted within 90 days as of February 2023.
Since these timelines vary, it’s essential for clinicians to check the policy of each payer you are billing to ensure you file a claim in accordance with their timely filing policy.
How to request proof of timely filing
Claims submitted outside of the timely filing window are likely to be denied. In certain circumstances, an insurer may receive a claim after the filing deadline, despite the biller or clinician filing it on-time. In instances like this, you’ll need to obtain proof of timely filing to the payer to get the claim submitted for processing. We’ve included a place to add proof of timely filing in our timely filing appeal letter template.
Note: You can only obtain proof of timely filing when submitting claims electronically.
There are a few of ways to obtain proof of timely filing:
- If using an EHR like SimplePractice to submit claims, you can ask the support team for proof of timely filing. Simply submit a help request with the clearinghouse reference number.
- Look for, and print proof of, an acknowledgement. For example, The Centers for Medicare & Medicaid Services (CMS) color codes claims:
- Blue indicates awaiting acknowledgement
- Green means acknowledgement received
- Red is an error
- Yellow means resubmitted/archived
- Check the clearinghouse the claim was submitted to (the client’s insurance card should indicate the clearinghouse used by their payer) and request proof of timely filing according to their process.
Appealing timely filing denials
It is possible to appeal a timely filing denial. Most payers allow providers to submit what is called a reconsideration request. It is likely that the insurer will stipulate reconsideration attempts meet certain criteria, such as:
- The timely filing missed deadline being beyond the providers control (for example, due to the clearinghouse mismanagement of your claim)
- Delays due to the postal service
- Insurer error
What to include in a timely filing appeal letter
You can download our free timely filing appeal letter above. You’ll want to ensure you include the following information in your timely filing appeal letter:
- Patient name
- Health plan ID number
- Group ID
- Claim number
- Date of service
- Provider ID (if applicable)
- Provider name and contact information
- Total billed and any reference number
- Proof of timely filing (if applicable)
- Reference to their policy referencing timely filing appeals/extenuating circumstances making a timely filing waiver request
After including the above information, request that the insurance company reconsider your claim for processing.
Note: The payer may also require you to complete a reconsideration form, indicated in their policy guidelines.
Sample timely filing appeals letter template
As we mentioned, there are a few reasons why timely filing denials occur and you can customize our timely filing appeal letter template accordingly.
You may also find the following sample paragraphs helpful:
Claim within the timely filing period
“The above claim was submitted on [insert date]. Despite being within [insert insurance name] timely filing limits, the claim was denied due to [insert reason]. Please note, however, that this claim was originally sent within the timely filing limits.”
Proof of timely filing
“I have attached copies of the original claims sent [electronically / hard-copy] on [date]. This date was within the timely filing limits [insert payers timely filing deadline]. Thus, the claim should have been paid upon receipt.”
Documentation
“I have enclosed a copy of a report produced by [name of clearinghouse] demonstrating the original submission date of [insert date of submission] which was within your timely filing submission period.”
Reconsideration request
“I respectfully request that [insert name of insurance company] reconsiders the claim and pays for services rendered promptly.”
Note: You may wish to include a reference to your state’s prompt payment guidelines and express your intention to file a complaint with your state Office of Insurance Commissioner, should the resubmitted claim be denied.
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