Simplifying Timely Filing
Updated May 15, 2023
Originally Published July 18, 2023
Essential Strategy For Revenue Cycle Success
Timely filing might sound simple—but a single delay or small error can wreak havoc on a practice’s revenue. Just one rejected claim means lost reimbursement and wasted time.
What is Timely Filing?
Timely filing refers to the deadline set by each insurance payer for when a claim must be submitted. These limits can vary: some payers give providers a year, while others allow as little as 30 days. If the deadline is missed, the claim is denied, and there is no reimbursement.
Even though technology has sped up claim submission, delays still happen. Claims must be built, scrubbed, and processed before they’re submitted. If something slows down that workflow—like missing documentation or a backlog—you’re suddenly up against the clock.
For example, Medicare requires claims to be submitted within 12 months of the date of service. If a biller doesn’t submit in time—or if the provider doesn’t pass along the necessary information quickly—Medicare won’t pay the claim. Period.
Twelve months might sound like plenty of time, but when you're working in an enterprise practice that sees hundreds or thousands of patients per week—or juggling dozens of different payer rules—things can fall through the cracks fast.
If the timely filing criteria aren’t met, then no one gets paid. That means more rework and less reimbursement.
Why is Timely Filing Important?
Timely filing isn’t just a best practice—it’s a make-or-break element of the revenue cycle. Providers don’t want to lose revenue for services they’ve already delivered, and billers don’t want to spend time on work that never pays off.
And no—patients aren’t on the hook if a claim is filed too late. That responsibility stays with the provider, which makes timely filing a must-do, not a nice-to-have.
If your PM system supports batching claims and organizing workflows by payer deadlines, you’ll save time, reduce errors, and avoid preventable denials.
According to a 2024 survey, 77% of healthcare providers reported an increase in claim denials, up significantly from 42% just two years earlier. Timely filing errors remain one of the most common causes.
By staying on top of filing deadlines and submitting claims correctly the first time, you reduce your denial rates and keep cash flow steady.
Common Timely Filing Questions
What happens if a claim is denied due to timely filing?
If a claim is denied due to timely filing, the provider (and possibly you) do not get paid for the service, and the claim may require resubmission, often with additional documentation or appeal steps.
Can you appeal a timely filing denial?
In some cases, you can appeal a timely filing denial, especially if there was an extenuating circumstance (like missing provider info or a system error). However, appeals have their own deadlines and complications.
Do all payers have the same filing limits?
No, each insurance company or payer has its own filing timeline, ranging from 30 to 365 days. It’s important to track each payer’s specific deadline to ensure timely submission.
Tips to Avoid Timely Filing Denials
Use Automation: Set up automated alerts in your PM software to flag claims nearing their filing deadline.
Track Payer Rules: Store specific filing limits for each payer in your system to avoid confusion.
Maintain a Smooth Workflow: Ensure timely submission by streamlining communication between billers and providers and in RCM routines.
Run Regular Reports: Regularly check for unbilled claims and overdue services to stay ahead of deadlines.
Set Reminders: Use reminders for critical actions like submitting claims or deadlines for processing necessary documentation.
OpenPM Makes Timely Filing a Priority
Any PM software should make timely filing easier—but many systems still don’t prioritize this function. OpenPM does.
We make it simple to stay on top of payer rules and timelines. For example, you can set a default number of days for timely filing by insurance billing groups—so no one has to memorize every deadline. This reduces the mental load for busy billers and helps prevent unnecessary denials.
Even the best biller in the world can miss a deadline. That’s why choosing a PM system that supports you is key. We’ve built tools that help billers and providers succeed.
