If an insurance company states that they never received your claim and the system indicates that it was acknowledged, then the payer may ask for Proof of Timely Filing.
Note: Proof can only be provided for electronic claims.
Step 1: Was acknowledgment received?
You will want to go to your CMS-1500 Filing and check to see if the claim has a green color code. If the color is green, then the system received a 999 Acknowledgment file from the clearinghouse. If the color is blue, then the system has not yet received an acknowledgment. If the color is blue, then there is not a way to show timely filing.
Step 2: The Clearinghouse
The process for obtaining proof is dependent on the clearinghouse the claim was sent to. While you can typically look at the insurance card on the client's chart to determine the clearinghouse, it is recommended that you look at the 999 or 277 file, because you will need other information from them regardless.
As previously mentioned, 999 files are sent from the clearinghouse that acknowledges that they received the claim. A 277 file is sent from the payer directly. These files contain important information about the claim that you had sent.
While in the CMS-1500 Filing area:
- Locate the acknowledged claim you need Proof of Timely Filing for.
- Click the icon and select View Status Messages. This will open a new window. Note: The Claim ID seen on this window is the internal number assigned by the system. This is not the Claim ID that will be used for proof.
- As messages received are placed in ascending order, you will want to focus on the entry listed at the bottom and select View Details. This will download/open a .txt file that can be opened with various programs, such as Notepad. If you are using Notepad, it'll be easier to read the file you open the Format drop-down and select Word Wrap.
- Locate the [CLEARINGHOUSE] bracket and look to the right of the => text. This will indicate the clearinghouse that this claim was sent through.
- OA - Office Ally
- AV - Availity
- JP - Jopari
- When looking at this file, check to see if there any number listed for [PAYER_REF]. This is the reference/claim number provided by the payer. If this is present, then you might be able to provide this to the payer to locate the claim and avoid needing proof.
Step 3: Requesting Proof of Timely Filing
Once you have determined the clearinghouse, you can proceed with requesting proof.
- Navigate to Request Timely Filing Letter
- Enter eiassistant as the Office Ally Username (login).
- Enter the Office Ally Claim ID(s). This is found within the 999/277 file that was used to determine the clearinghouse. It will be listed next to [CLAIM_ID].
- Enter all other information, if applicable. For Payer ID/Payer Name, that information can found on the client's insurance card in the system or by viewing the EDI file.
- To view the EDI file from your CMS-1500 Filing area, click on the icon and select View EDI File. In this example, it is MR008.
- Follow the instructions on the form for submission.
You will have to request a letter of proof by emailing email@example.com. The information that you must supply is as follows:
- Client Record Number - Located on the client card under Clients > Client List.
- Insurance Company
- Date(s) of Service
You must contact Jopari directly to obtain timely filing proof. They will ask for information to identify your clinic and the client. For contact information, please see: Contact Jopari