Denial Code CO 29

Denial Code CO 29 – The time-limit-for-filing has expired.

Timely filing limits for insurance claims vary depending on the specific insurance company and the terms outlined in the provider contract. Each insurance provider establishes a specific timeframe within which healthcare providers must submit claims for reimbursement. It is crucial for providers to adhere to these timely filing limits to ensure that their claims are processed in a timely manner.

Failure to submit a claim within the designated time frame can result in the insurance company denying the claim with denial code CO 29. This denial code signifies that the claim was not submitted within the required timely filing limit and is therefore ineligible for reimbursement.

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 the scenario presented, the patient received treatment on 03/14/2023, and the provider billed the claim to UHC insurance on 08/18/2023. However, UHC insurance is likely to deny the claim with denial code CO 29 due to the timely filing limit of 90 days from the date of service. This means that the provider was required to submit the claim within 90 days from the date of service, which in this case was 06/12/2023. Since the claim was submitted after this time frame on 08/18/2023, it falls outside the allowable period for reimbursement according to UHC insurance guidelines.

Denial Code CO 29 Solutions:

• The first step in ensuring timely claim submission to insurance is to verify the specific deadline established by the insurance company for billing.
• The next step in the process is to check when the payer received the initial claim from the provider.
• Next step is to calculate the time limit for filing a claim, use the following formula: Time taken for filing a claim = Claim received date by payer from provider – Date the service rendered from provider to patient. This formula helps determine the period within which a claim must be submitted to the payer after the service has been provided to the patient. It involves subtracting the date the service was rendered from the date the claim was received by the payer.
• After calculating, if a claim is submitted within the timely filing limit but is incorrectly denied by the insurance payer, it is crucial to take immediate action to ensure accurate reimbursement. This involves reaching out to the payer’s claims department representative to address the issue and request a reprocessing of the claim.
• When a claim is submitted after the filing limit, it is imperative to review the application thoroughly to determine if there is any Proof of Timely Filing (POTF) available. The POTF serves as evidence that the claim was indeed submitted within the required timeframe. If such proof exists, it is essential to appeal the claim and provide the POTF to support the request for reimbursement.

Proof of timely filing example:

Consider patient initially received treatment from a provider on 02/15/2023, and the provider billed the claim to Cigna insurance on 05/02/2023. However, Cigna denied the claim on 05/24/2023, citing the need for a Primary Explanation of Benefits (EOB). Upon investigation, it was discovered that the patient’s primary insurance is with UHC, with Cigna acting as the secondary insurance provider.

The provider subsequently submitted the claim to the primary insurance, UHC, on 06/01/2023 for reimbursement. Unfortunately, UHC denied the claim on 06/16/2023, issuing denial code CO 29.

UnitedHealthcare (UHC) typically has a 90-day timely filing limit from the Date of Service (DOS) for participating providers. If an insurance company correctly denies a claim due to being outside of this timeframe, it is generally deemed non-reimbursable.

However, a unique scenario arises when dealing with multiple insurance carriers. If an initial claim was submitted to Cigna within the 90-day timely filing limit and was subsequently denied, the Explanation of Benefits (EOB) from Cigna becomes a key piece of evidence. This document serves as Proof of Timely Filing (POTF), indicating that the claim was indeed filed within the required timeframe.

Armed with this POTF from Cigna, providers can leverage it to appeal the claim to UnitedHealthcare for reimbursement. By presenting the Cigna denied EOB as evidence of timely filing, providers can make a compelling case for UHC to reconsider the claim and process it for payment.

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

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