Getting Paid for Late Claims
By Barbara Griswold, LMFT (Updated July 10, 2017)
What might be considered “good cause?” While I don’t have data on “successful excuses,” I would consider filing a dispute for reason of illness, injury, hospitalization, caring for an ill family member, significant personal issue (ex. divorce, death), problem with biller/electronic billing, or other unforeseen event. What have you got to lose?
- Client information [ex. Name, plan ID#, date of birth, Social Security #, dates of service]
Why the treatment delivered was medically necessary
- That your delay did not involve willful neglect/misconduct
- That “good cause” for the delayed filing existed (discuss reason).
- The amount of money owed to you3
What if my dispute fails? You can appeal to your state’s Department of Insurance or Department of Managed Care. A plan that I had billed electronically denied receiving it on time, and refused to pay even after I appealed and provided proof of timely filing from the online claims clearinghouse . After filing an online complaint with the state, I was paid.
- Before submitting the claim, be sure you’ve included every session
- Submit claims as quickly as possible after session
- Review charts regularly to see if claims haven’t been paid, so you can follow up and have time to resubmit, if needed
- File electronically, and save filing acknowledgements (non-contracted providers can even file electronically for clients)
- Review health plan contracts for filing deadlines