Skip to main content

Here’s how to request waivers of the timely filing policy

 

In a perfect world, you should collect insurance information from members at the time of their visit and file the claim right away. Most providers have 120 days from the date of service to file a claim. But the world’s not perfect. Sometimes you get the wrong insurance information. Sometimes you send in the claim but for some reason, we didn’t get it. Not to worry. Sometimes we can waive the timely filing requirement with a written request to appeal or reconsider.

 

If you want us to consider a claim after the timely filing period, here are some items we’ll accept as proof that you tried to file a claim on time (proof of prior submission applies to participating and nonparticipating providers): 

  • Receipt of a claim with a letter from Aetna attached, showing original claim submitted within the required time frame.
  • Copy of your ledger card (for example, a computer printout or a copy of the actual ledger showing the date of service, date you billed Aetna, etc.
  • Proof you submitted an electronic claim within the required time frame, and we received or rejected it. 
  • Copy of Aetna’s Explanation of Benefits (EOB) statement.
  •  Copy of the EOB statement from another insurance company, indicating that the claim was sent to the wrong carrier but was sent within the timely filing period. 
  • Letter from Aetna requesting corrected information (such as member ID number), showing original claim was submitted within required time frame. 
  • Information in a call or contact history indicating that you filed the claim appropriately (that is, that you filed within the required time frame and contacted us regarding receipt of the claim).

 

For more information on timely filing standards, state by state, visit aetna.com. Click on “Providers,” then on “Providers Overview.” In the Resources section, click on “Regulations by State.”