Sample Timely Filing Appeal Letter

Posted in Appeal Letters

Insurance companies have a time limit for filing claims built in to their contracts with providers. These timely filing limits can range anywhere from 90 days to a year depending on the contract with the provider. When claims are filed for the first time after the timely filing limit they will be denied; however when the insurance company issues a denial in error, the provider, or even the patient, can submit a timely filing appeal letter.

Format and Content
A timely filing appeal letter format should include all pertinent information regarding the patient, includingidentification, group, policy and claim numbers, patient name, date of birth and date of service. The individual writing the appeal should reference the provider and the provider contract along with the reason the appeal is being submitted.

Sometimes insurance companies take a few days or even weeks to update their records when changes are made on provider contracts. In the case of this timely filing appeal letter sample, the provider negotiated a new contract with ABC Insurance Company on March 1, 2013 in which the timely filing limit was changed from 90 days to 180 days. A claim that was filed in August within the 180 day timeframe was denied for not being filed timely, but the insurance company incorrectly referenced 90 days as the timely filing limit on the denial. The provider is appealing the denial.

Agnes Moore
Denials Manager
XYZ Orthopedic Group
123 Hospital Drive
Suite 700
Boise, Idaho 33333
Arthur Top
Appeals Representative
Denial Appeals Department
ABC Insurance Company
P.O. Box 456
Boise, Idaho 33333
September 1, 2013
RE: Patient: Joseph Black




Date of birth: 11-12-1958
Date of Service: 04-15-2013
Dear Mr. Top,
This timely filing appeal letter is regarding the patient Joseph Black whose information is listed above. I am appealing the timely filing denial we received on Mr. Joseph’s account on August 30, 2013. Apparently your records have not yet been updated; because the timely filing limit XYZ Orthopedic Group negotiated with ABC Insurance Company in our most recent contract signed on March 1, 2013 is 180 days from the date of service. We are no longer under the 90 day timely filing limit rule that was written into our previous contract.

Mr. Joseph was seen in our office on 04-15-2013 for a leg fracture at which time Dr. Avery Smith set and casted the leg which healed properly requiring no surgery. We filed Mr. Joseph’s claim on August 15, 2013 which was well within our timely filing limit of 180 days specified in our latest contract that went into effect on March 1, 2013. We respectfully ask that you reconsider Claim
789 for this particular patient using the rules outlined in our most recent contract.

For your convenience, I have attached a signed copy of the contract dated March 1, 2013 between XYZ Orthopedic Group and ABC Insurance Company along with a copy of the original Claim
789 that was filed on August 15, 2013. Please feel free to contact me at the number or email address listed above should you have any questions or require additional information.
Agnes Moore
Agnes Moore
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