Timely filing appeals are simple and straightforward.
In fact, the timely filing appeal letter is often merely a cover letter for timely filing documentation. A typical timely filing appeal briefly states that proof of timely filing information, such as patient account notes or electronic claim acknowledgment, is attached. Based on the documentation, payment is requested.
However, a successful appeal always covers all three steps to appeal success: a demand for denial disclosure, reference to compliance information such as claim processing laws or contractual obligations and, finally, customized claim details.
It sounds like a lot to cover. However, the wording can be brief, highly effective and insure that your appeal receives the highest quality review.
Notice how the following timely filing appeal letter template anticipates what might go wrong in the appeal review and demands information related to a potential repeat denial, just in case.
Dear Provider Appeals,
It is our understanding that this treatment was denied pursuant to your internal timely filing requirements.
It is our position that the claim was timely filed. As you know, state and federal protections may specify the time frame for claim submission and clean claim requirements. Therefore, we request a review of this denial by a claims processing professional familiar with the applicable regulations regarding clean claim processing. If benefits remain denied, please furnish the name and credentials of the claims professional who reviewed the denial and the reviewer’s response to the following:
- Please review the attached patient account notes and confirm or deny any receipt of correspondence from our office subsequent to this date. In particular, we direct your attention to the following information which documents the initial filing date (customize to reference date of initial filing and any related acknowledgment from carrier).
- If your company requires additional documentation of the filing date, please specify the exact information required such as clearinghouse notes or affidavit from biller attesting to filing date.
- Please review the denial for compliance with (customize to cite your organization’s contract terms regarding timely filing and/or state or federal requirements regarding timely filing and clean claims).
Based on this information, we maintain our request for payment of this claim. If benefits remain denied, please provide all of the above referenced information so that we may assess the timely filing review and determine our rights in regards to this matter.
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