Wiki Timely Filing

[tammigerges]

Hi
I do Physical Therapy billing and I am dealing with Amerigroup. I am being told that since a claim is rejected and not formally denied that i will get hit with timely since the claims are from April/2013. The don't consider the claim to be on file until a formal denial is made. Does anyone have experience with this?

 

[animesh.s]

Animesh Sharma

Hi

There are 2 things (not only Amerigroup but all payers)

(1) If a claim has been denied and we have appeal rights, the claims comes out of the Claims filing limit criteria and falls under the category of Appeals filing limit criteria from the date of denial
(2) If a claim has been rejected by the EDI of payer claim adjudication system or in other words it falls under the payer rejection category, that claim will still be in the Claims filing limit criteria because the payer never processed and assigned a claim# to this claim
(3) We do have certain denials as well which falls under the claims filing limit criteria (depends on payer). Example. Some payers keep bundled denied claims under claims filing limit criteria if provider wants to make correction and resubmit a corrected claim
I hope i am able to answer your question

Thanks
Animesh Sharma