Timely Filing in Dental Billing: How to Avoid Denials and Fight Them

Table of Contents

1. What is "timely filing"?

2. How to avoid timely filing issues

3. Tips to fight timely filing denials

In dental billing, one of the most stressful type of denials to handle pertains to "timely filing." Understanding what timely filing of claims means, how to avoid missing the deadlines, and strategies for dealing with timely filing denials is crucial for the financial health of your dental practice. Let's delve into these aspects to ensure your claims process runs smoothly and efficiently.

What is Timely Filing of Claims?

Timely filing refers to the specific time frame within which dental claims must be submitted to the insurance provider. This period can vary significantly depending on the insurance carrier, ranging from as little as 30 days to as long as one year or more from the date of service. Submitting claims within this window is essential to ensure they are processed and paid by the insurer. Failure to submit claims on time can result in denials, leading to lost revenue for your practice.

How to Avoid Timely Filing Issues

Avoiding timely filing issues requires a proactive approach and a well-organized system. Here are some key strategies:

1. Know the Deadlines

• Stay Informed: Keep an updated list of filing deadlines for all insurance carriers your practice works with. This list should be easily accessible to your billing team.
• Regular Updates: Insurance policies and deadlines can change, so ensure that your team regularly checks for updates from the insurance companies during your insurance verification process.

2. Implement Efficient Workflow Systems

• Streamlined Processes: Develop a standardized process for documenting and submitting claims promptly. Ensure all necessary documentation is gathered and reviewed as soon as possible after the service is provided. For a deeper dive into having prompt supporting documentation to submit claims, take a look at our clinical to admin transfer blog, and listen to our clinical to admin transfer podcast. 
• Delegate a specific team member(s) to monitor and track claim submissions. Claims should go out within 48 business hours at the most. 

3. Training and Education

• Staff Training: Regularly train your billing staff on the importance of timely filing and the specific procedures your practice has in place.
• Continuous Education: Encourage ongoing education about not only changes in dental billing and insurance regulations, but also promptly verifying and updating insurance information for patients for all appointments to ensure claims are being sent to the correct insurance carrier. 

4. Regular Audits

• Internal Audits: Conduct regular audits of your billing processes to identify any delays or potential issues before they lead to missed timely filing deadlines. Your clinical team should understand this as well as they need to provide prompt and accurate information and documentation to support the prompt submission of claims. 
• Performance Metrics: Track the performance of your billing team with metrics such as completed appointments to claim submission turnaround times, and denial rates by reason to identify areas for improvement. 

A common myth in dental billing:  "Timely filing denials are not appealable"

Despite best efforts, there may still be instances where claims are denied due to timely filing issues. Don’t give up! Here are some tips to handle such denials:

Tips to Fight Timely Filing Denials

1. Review the Denial

• Detailed Examination: Carefully review the denial notice to understand the specific reason for the denial. Sometimes, there may be an error or a miscommunication that can be rectified. Insurance companies do make mistakes.
• Documentation: Gather all relevant documentation that supports your case, including proof of timely submission if available, or proof that the patient provided incorrect information to you to file. 

2. Appeal the denial

• File your appeal within the allowed time frame, which varies by company and is often shorter than timely filing deadlines
• Provide a clear appeal letter with necessary documentation and an explanation of why the claim should be reconsidered, such as proof of timely submission from your clearinghouse.

3. Leverage Relationships

• Insurance Contacts: Develop good relationships with representatives from the insurance companies. Sometimes, having a direct contact can expedite the resolution process.
• Professional Associations: Utilize resources and support from professional dental associations which may offer assistance or additional leverage in dealing with denials, such as Wisdom. It is not uncommon for a backlog of timely filing denials to occur if untrained team members were submitting claims, your office was closed, or there was a clearinghouse issue, amongst other things. Don’t be afraid to ask for help!

Timely filing of claims is a critical aspect of dental billing that can significantly impact your practice’s revenue cycle. By understanding what it entails, implementing best practices to avoid filing issues, and having a strategy in place to address denials, you can ensure a more efficient and profitable billing process. Stay informed, organized, and proactive to keep your claims on track and your practice thriving.

Need help with managing your dental revenue cycle management processes? Contact us today to learn more about how our expertise can streamline your billing and maximize your revenue.

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