Timely Filing: Friend or Foe?

One of the biggest pain points we hear from new providers when adding to our network is that they “…haven’t been paid on old claims by the insurance company”. They follow-up that question with, “can you help us?” The short answer is yes, but it might not be how you think. Most of the time it comes down to timely filing.

Before we dive into timely filing, let’s talk about jurisdiction. People move. Part of the confusion providers have with workers comp claims is when a patient is from out of state. Each state has its’ own laws and procedures that dictate how a claim is supposed to be processed. When dealing with out of state patients, you cannot treat them the same as those in your home state. I think that’s the biggest reason why so many providers depend on us to help sort through the mess of discovering where a claim should be sent, on what form, how fast, does diagnosis code matter, can I even bill this code? You see my point.

So let’s get back to timely filing. What does it mean? On a basic level, it means you have “X” number of days to get a complete, supported bill to the payor of the claim. The “X” in the equation is usually between 60-120 days depending on the state. But providers are not the only ones who are limited on time. Payors have a limited number of days to respond back to you. This keeps the process moving. This keeps patients from getting lost in the litigation and paperwork.

Timely filing can be a touchy subject to discuss when you have great providers that focus on care and not claims.  Some providers, especially those who do not focus on work comp, can find themselves so frustrated by the billing process they choose not to accept work comp patients.

I cannot disagree with sticking to what you do best. But should a procedural process impede care or growth of a small business? No, but those procedures are there for a reason.

I think that is why many providers choose partners like CentralComp. We can process claims in a way that gives comfort to both the provider and patient. Our providers do not worry about getting paid. Our patients get to stay with the provider they feel most comfortable with. They know we are there to support them as much as we support our clients.

Ultimately, timely filing works to the benefit of everyone. The claimant doesn’t have to worry about handling bills the same as they do with their private insurance. The adjuster knows once a treatment is complete, they can close the file. The provider knows that the insurance company is required to respond to the bills within a short period of time. The world of work comp stays a little more balanced as a direct result of putting time limits on the billing process. Can it hurt? When you aren’t sure how it works, yes; but it doesn’t have to.

At the end of the day, choose to work with people who know how states differ, who know when changes are happening in every state.