Proof of Timely Filing

Question: I file claims within one week of seeing the patient. There are some insurance companies that do not pay the claims. After calling repeatedly, we are told to submit proof of timely filing. On our insurance forms when the claim is put into records, it records a date that this is done.

For example, if we see a patient on Jan. 1, 2008, and I put the claim into the computer on Jan. 3, the latter date is put on the form. I cannot change this date. These insurance companies say that this is not proof and that in the future we should send our claims certified mail. If I send an envelope with more than one claim in it by certified mail how can I prove that a particular claim was in that mailing? What, in your expertise, constitutes proof of filing?

Answer: You should ask the insurance companies (or check their Web sites to see) what they do accept as proof. Each has its own ideas.

For example, here is what Horizon BC/BS says:

Horizon NJ Health’s Appeals department utilizes specific criteria when reviewing valid proof of timely filing. The information submitted should consist of a computer-generated ledger that cannot be altered and includes the following information:

• Member’s name

• Horizon NJ Health ID No. or Medicaid identification number

• Billed amount

• Date of service

• Billed/mailed date

• Address where the claim form was sent (Horizon NJ Health or insurance code)

• For EDI submissions, a 997 report indicating submission to the correct insurance code is required for consideration of timely submission.

You also should look into filing the claims electronically, which can provide a stronger paper trail and faster filing as well.