Denial Code CO 29

Aetna timely limit for filing claims – Aetna Better Health & Medicare (medicalbillingcycle.com)

Timely filing limit varies from insurance to insurance and also it depends on the provider contract. Insurances have set a time frame to submit the claims from provider for reimbursement and provider has to make sure to send the claims within the set timely filing limit in order to process the claim. If provider bill the claim after the set time frame, then the insurances will deny the claim with the denial code CO 22.

For example:

Consider patient took the treatment on 03/14/2023 and patient is having a UHC insurance. Provider billed the claim to UHC insurance on 08/18/2023 for reimbursement.

In this case UHC insurance will deny the claim with denial code CO 22, because UHC insurance timely filing limit is 90 days from the date of service and claim submitted after the time frame.

It means provider has to submit the claim within 90 days from the DOS, so the DOS is 03/14/2023 and provider should bill the claim within 90 days i.e., 06/12/2023 to UHC for reimbursement. But claim submitted on 08/18/2023, which is after the time frame.

Denial Code CO 29 Solutions:

• First step is to check the time frame set by the insurance to bill the claim to them.
• Next step is to check, when the payer received the initial claim from the provider for reimbursement.
• And then we need to calculate the time limit with the following formula: Time taken for filing a claim = Claim received date by payer from provider – Date the service rendered from provider to patient
• After calculating if claim submitted within timely filing limit but insurance denied incorrectly, then we need to reach out payer claims department representative and send the claim back for reprocessing.
• If the claim submitted after the filing limit, then we need to see the application and verify whether we have any POTF (proof of timely filing). If we have proof which states claim submitted within the time frame, then we need to appeal the claim along with Proof of timely filing for reimbursement.

Proof of timely filing example:

Consider patient received a treatment from Provider on 02/15/2023 and provider bill the claim initially to Cigna insurance on 05/02/2023. Cigna received the claim on 05/10/2023 and denied the claim on 05/24/2023 as Need Primary EOB.

Upon checking found patient is having UHC insurance as primary and Cigna is secondary. Now provider billed the claim to primary UHC on 06/01/2023 for reimbursement. But UHC insurance received the claim on 06/12/2023 and denied the claim on 06/16/2023 with denial code CO 29.

UHC timely filing limit is 90 days from the DOS for participating provider and insurance denied the claim correctly. But we can consider Cigna insurance denied EOB as proof of timely filing as we initially submitted the claim to Cigna within timely filing limit i.e., 90 days. In this case we can consider that as POTF (Cigna denied EOB) and appeal the claim to UHC insurance for reimbursement.

Medical Billing Denials and actions – Top Denial codes Solutions (medicalbillingcycle.com)