What is the TRICARE timely filing limit? Under TRICARE’s published rules, a claim must be received within one year of the date of service, or one year from discharge for inpatient facility stays. Late claims are generally denied unless a documented exception applies, such as retroactive eligibility or delayed primary insurance. A missed payer deadline…
What providers need to know about 2027 CPT codes starts with scale and timing. The AMA’s 2027 CPT code set adds 299 new codes, revises 74, and deletes 80. All changes take effect January 1, 2027, and maternity care sees the largest operational shift. Code changes rarely announce themselves until claims start bouncing back. This…
Improving cash flow through faster claim turnaround means shortening every controllable day in the claim lifecycle — charge entry, coding, submission — so that once a claim reaches the payer, it starts a payment clock that’s already working in the practice’s favor. Payers operate under fixed processing windows regardless of how a claim was billed,…
Patient statement generation for faster collections is the process of preparing, validating, and delivering itemized billing statements to patients as soon as possible after insurance adjudication, so the balance still feels connected to the visit. Practices that automate this step commonly report a practical target of getting the first statement out within a few days…
The average timeline for insurance payer enrollment runs roughly 90 to 120 days for commercial payers, 45 to 90 days for Medicare through PECOS, and anywhere from 45 to 180 or more days for Medicaid depending on the state — measured from a complete application to an approved, billable effective date. That range isn’t arbitrary:…
Payer-specific claim submission rules are the formatting, documentation, coverage, and modifier requirements an individual payer layers on top of the national HIPAA claim standard, and they explain why the exact same clean, correctly coded claim can be accepted by one payer and rejected by another. Every claim starts from the same base — the ASC…
Posting insurance payments accurately means matching each payer remittance — ERA or paper EOB — to the correct claim and service line, applying the right contractual adjustment, and flagging any underpayment or denial before the balance moves any further through the revenue cycle. Best practice is to post within 24 to 48 hours of receiving…
Handling secondary insurance claims correctly means submitting to the primary payer first, waiting for its Explanation of Benefits (EOB), then submitting the secondary claim with that EOB attached so the second payer can apply coordination of benefits (COB) rules to the remaining balance. The order matters: a secondary claim submitted before the primary has adjudicated,…
Tracking unpaid claims efficiently across payers means working from a payer-segmented worklist — not one blended aging report — so that each claim gets followed up before its specific timely filing deadline, using the age, dollar value, and payer of every open claim to decide what gets worked first. A single combined aging report can…
What Is Claim Rejection Rate? Claim rejection rate is the share of submitted medical claims that a payer or clearinghouse bounces back before adjudication, usually due to missing, invalid, or mismatched data. A practical target most well-run practices work toward is keeping this figure under roughly 5%, since rejected claims never enter the payer’s review…