Simply put, it has a low chance of appeal after you’ve received the denial, thus you lose money.
Aetna claims timely filing limit code#
Submitting a claim past an insurance's timely filing limit will come back to you as Claim Adjustment Reason Code (CARC) 29 and state, “The time limit for filing has expired.”ĬARC 29 has a high chance of prevention but a low overturn rate. On the flipside, if your team isn't familiar with the limits for the insurances the majority of your patients use, you're losing revenue. Aetna has announced timely filing limits for non-participating providers will be reduced from 27 months to 12 months for traditional medical claims beginning Jan. Knowing the deadlines of payers that attribute to most of your revenue before your patients visit your office will help your team anticipate and submit your claims faster. Why not use it as a guide to help identify the most important timely filing limits your team should be aware of? It's helpful in breaking down what percentage of revenue comes from common insurances. When speaking to our clients, most of them know their payer mix.Ī payer mix is a listing of the different healthcare insurances your patients use. But which are they actually using? Of course, I'm referring to what's known within the industry as a "payer mix." There are hundreds of thousands of insurance options your patients can choose from. It is important to note that balance billing members is prohibited under all Mercy Care health plans.
Aetna claims timely filing limit manual#
Some of those responsibilities include patient care, coding, and keeping track of healthcare requirements.Įnsuring your team is submitting patient claims on time is another important responsibility you need to know. Our updated Mercy Care Claims Processing Manual is now available to assist you with any claims or billing questions you may have. With a small amount of extra effort, you can lower your timely filing denial rate even more.Ĭhances are, you and your staff already have a ton of work to complete on a daily basis. As a simple example for reference, 0.01% of $3,000,000 is $30,000.įurthermore, that percentage is only true if you have all of those payers and submit an equal amount of claims to each. Rehabilitation Alliance is maintaining the records on a monthly. If the deadline isn’t 180 or 365 days then there’s a 56% chance that the limit is 90 daysīy submitting your claims within 90 days the chances that you receive a claim denial related to timely filing is 0.01%.Ī 0.01% chance stacks the odds in your favor, although that percentage can still have a significant negative effect on your bottom line if you aren't vigilant. column to calculate claim turn around time on the Aetna Capitation Distribution Excel file. If the deadline isn’t 180 days then there is a 46% chance that their limit is 365 days
There is a 34% chance that an insurance company has a deadline of 180 days The two most popular timeframes are 180 days and 360 days
From the bar graph and statistical data above we can conclude that…
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