Provided by:  Jennifer Kirschenbaum, Esq.


March 21, 2019



Below are comments received on Tuesday's email on untimely filings - 

Hi Jennifer,

If this is an employer provided plan the provider can invoke ERISA if the subscriber has a longer time period to file claims based on the subscriber’s policy with the employer.  If not, the provider can provide proof that the claim was timely filed to the first insurance company and write an appeal letter to the plan indicating that the patient provided incorrect information at time of service and that they timely filed the claim to “ABC” Insurance as soon as the patient provided the correct information to the practice. Always copy the patient when writing this type of letter to the insurer.  You need to fight but you should ultimately prevail!  

One other thing to point out….if the provider Is contracted with the insurer, the provider may be in violation of their contract if they balance bill the patient after a timely filing denial by the insurer!

Theresa Wilson CMRS, CPCO
Practice Synergy, LLC 
45 Carey Ave., Suite 101 
Butler, NJ 07405 
862-210-8008 x101
862-772-1877 fax
201-978-7277 cell