45 Day Rule

Generally, bills for reimbursement of services must be submitted within 45 days from the date of service. This is commonly known as the 45-day rule.

Sometimes, a healthcare provider has complied with the 45-day rule, but will nevertheless receive a denial for failure to submit bills within the 45-day time limit. Our experience shows that there are typically two reasons for receiving a denial on this basis:

• Though the bills had been submitted within the 45-day time limit, the carrier received them after 45 days from the date of service; or
• The carrier did not receive the bill and upon being sent the bill for a second time, denied based upon a violation of the 45-day time limit.

These types of denials can be easy to prevail on. All that is required is admissible proof of mailing that shows that the bill was sent within the 45 day limit. However, there are other ways to prevail in these cases as well. Get started to find out how. Contact The Sigalov Firm today.