Wiki Old Claim

[knperry]

I came across an old claim in the system and I saw that the primary insurance was filed and a payment was made. No letter/bill was sent to the patient so after calling the insurance company and making sure that the balance was the patients responsiblity, I mailed a letter to the patient. The patient called today and said he had a secondary insurance and I told him that information was not on file. He called the insurance company and they told him of course that I will have to appeal with a good reason why we didn't file the claim with them. I wasn't working here then and according to the information in the account, the patient did not have a secondary. I know the insurance company will more than likely deny the claim. Can I still bill the patient? Are there any rules that will help with this situation?

Thanks

 

[Candice_Fenildo]

I would call your provider rep and check your contract on the timely filing rules. If you are contracted with that payor, I would be more apt to say that you cannot balance bill the patient once the payor sends you a denial for timely filing.

We have had is occur once or twice, each incident the EOB specifically stated that the patients responsibility was "zero"

Good luck

 

[btadlock1]

I came across an old claim in the system and I saw that the primary insurance was filed and a payment was made. No letter/bill was sent to the patient so after calling the insurance company and making sure that the balance was the patients responsiblity, I mailed a letter to the patient. The patient called today and said he had a secondary insurance and I told him that information was not on file. He called the insurance company and they told him of course that I will have to appeal with a good reason why we didn't file the claim with them. I wasn't working here then and according to the information in the account, the patient did not have a secondary. I know the insurance company will more than likely deny the claim. Can I still bill the patient? Are there any rules that will help with this situation?

Thanks

Try to send it first - include the primary EOB, and a short letter explaining that the patient just provided their secondary insurance information (with the date it was provided). You never know - some payers allow up to a year from the primary EOB date, for secondary claims to be filed. If it denies for timely filing, then you can bill the patient. It's their responsibility to provide their information to you. Be prepared for a denial due to the patient not having their COB up to date, though. If that happens, get them to fix it, and have it reprocessed.

 

[airart]

Old Claim...

As mentioned above, the rules for secondary filing are different from a primary filing with insurance. Most secondary payers will give you anywhere from 180 days-1 ½ years to file a claim with a secondary payer. Did the secondary carrier mention the timely filing limit for secondary insurance? Did they know they are a secondary payer? Ultimately the member is responsible for all their medical care including the billing side of things.

Send the claim in to be processed to receive the timely filing denial if it's past the secondary timely filing limit. I usually have the patient fax me or email me a letter on their behalf to the carrier about their part of the error as well. I will usually send in the claim, primary EOB, member letter, and my appeal letter to hopefully avoid a denial right away.

If the claim is denied, then appeal with the reason that the patient did not give the information at the time of service. I have won appeals for payment this way before with a payer as proof that the provider is not at fault for the timely filing.

When a claim is denied timely filing the EOB usually does not put it as patient portion responsibility and the provider should write it off as it was their fault the claim was not timely filed. In your case however, it was not the fault of the provider unless they forgot to ask for secondary insurance at the time of the visit.

As for billing the patient, our office policy is to not bill the patient anything over a year from date of service.

 

[knperry]

Thank you every one!