Timely Filing Deadline Overview

Timely filing deadlines are payer-defined deadlines in which providers must submit claims for payment. Claims submitted after the deadline may be denied, resulting in loss of revenue for the provider. The Timely Filing Deadline feature allows users visibility into claims that are in jeopardy of missing payer timely filing deadlines so that they may take proper action. Access to this feature is managed with the View Insurance Master and Edit Insurance Master user/site privileges.

Define Payer Timely Filing Days

The first step to configure Timely Filing is to assign timely filing time deadlines to Payers. The Payer Timely Filing screen allows users to associate selected payers to the number of days in which you have to submit claims Timely Filing Deadlines). This screen contains a search feature where users may search, then assign, timely filing deadline days to one or several payers at one time.

To define timely filing days for Payers, access the Payer Timely Filing screen by clicking the Timely Filing button on the Payer Configuration screen (Admin > XClaim > Payer Configuration).

Define Timely Filing Thresholds

Once a timely filing day is assigned to a Payer, Thresholds are defined to help users identify claims that are within a certain number of calendar days from the Payer's Timely Filing Deadline. The Define Thresholds screen allows users to configure up to six color-coded thresholds. The color assigned to the threshold is the color in which the claim will appear in the claims grid when it is within that threshold with respect to the Timely Filing Deadline configured on the Timely Filing screen. Note that this feature does not work until the threshold is associated with a Timely Filing Payer Rule (next section) and a Timely Filing Deadline (previous section) has been defined for the intended Payer.

To define Timely Filing Thresholds, access the Define Threshold screen (Admin > XClaim > Timely Filing > Define Timely Filing Thresholds). From this screen, you may add or edit thresholds, as well as directly access the Define Timely Filing Rules screen.

Define Timely Filing Payer Rules

The final step to configuring Timely Filing is to define Payer Rules and associate them with thresholds. This allows for claim provisioning to users within predefined groups when a claim enters a specific threshold. There is also an option to send a system alert to the claim owner when a claim enters the specified Threshold. A user can create as many Payer Rules as necessary to ensure that the appropriate user/groups are notified to take action on claims prior to the timely filing deadline.

To create Payer Rules, access the Timely Filing Payer Rules screen either from the Define Thresholds screen, or from the Admin menu (Admin > XClaim > Timely Filing > Define Rules).