Timely filing is the denial you cannot appeal

The worst denial is not the complicated one. It is the claim that was ready months ago, got stuck behind a rejected batch or a missing modifier, and went out a week past the deadline. It comes back with claim adjustment reason code 29, "the time limit for filing has expired," and in most cases that is the end of it.

The limits are not the same everywhere

Medicare requires claims to be filed within 12 months of the date of service, under 42 CFR 424.44. Each state sets its own Medicaid limits. Commercial limits are set by contract and are often much shorter, commonly 90 to 180 days, and some plans give in-network providers a shorter window than out-of-network ones.

Secondary claims have their own rules, which often depend on when the primary payer processed the claim. A slow primary payer can use up much of your window. Check each payer's provider manual for the exact rule.

Why it hurts more than other denials

A timely filing denial is usually a contractual adjustment. Under most payer contracts the practice writes the balance off and cannot bill the patient. The care was delivered, documented and coded correctly, and the money is lost to the calendar.

Where the days go

• Charges are entered days after the visit.
• Claims rejected at the clearinghouse are never worked, so the payer never received them.
• Claims go to the wrong payer because coverage changed and nobody rechecked eligibility.
• Corrected claims are treated as low priority, even though many payers apply the same deadline to them.
• Secondary claims wait for a primary payer's remittance that nobody is chasing.