You have spent years training your staff on the proper intake of new patients, and the corresponding policies and procedures have been implemented in your office. Every new patient provides you with their ID card and every form imaginable is signed. The new patient is treated and your staff submits the claim form to the carrier. A few months go by and an EOB is received stating the patient wasn’t active with that payor. The patient is contacted and admits the wrong insurance card was provided. The claim is now submitted to the correct payor, but soon after, the EOB comes back denying the claim for untimely filing.

Don’t despair – send an appeal in and cite Florida Statute §641.3155(2)(b). This statute sets the time frame for submission of claims to the primary payor to be within 6 months after the discharge (or date of service) and from the date “[t]he provider has been furnished with the correct name and address of the patient’s health maintenance organization”. Along with your appeal, attach a copy of the EOB from the wrong payor showing you were procedurally timely and the denial should be overturned.