If a medical claim sent to Inovalon has been rejected due to Timely Filing limits, you can create an appeal letter directly within the Claims Management Pro portal. These steps will apply for both Institutional and Professional claims.

Creating Timely Filing Appeals

First, you’ll want to navigate to the Claims Menu and select either Institutional or Professional, and locate the claim(s) you wish to create appeal letters for. Once you have located these claims, you’ll select them by checking the checkbox on the leftmost column.

With those claims checked, you’ll click on the “More Options” button at the top of the Claims table and select “Create Appeals”.

In the resulting window, you’ll be able to choose the type of appeal letter you’d like to create. There are three “Timely Filing” options available, for Date of Service, Primary Denial Date, or a more generic appeal letter.

Once you’ve clicked Create, you’ll see this confirmation prompt:

Before you are done, you will want to review all created appeals to ensure they do not have any errors.

Managing Timely Filing Appeals

To look at any Appeals you’ve created, you’ll navigate to the Claims Menu and select Appeal Management > Appeals:

This will bring up a list of your Appeals. You’ll note that in the Status column, some are marked in red and some are in green.

Green appeals have been validated and will be sent to the payer for consideration. Red appeals have an Error in them that needs to be corrected. To resolve these, click the “Action” button on the right-most column.

This will bring up the appeal details:

Any fields highlighted in red need to be populated to process the claim. Review the highlighted fields and populate them with the missing or corrected data, and then once complete, you will click the “Save and Validate” button in in the upper right hand corner. This will ensure your appeal receives fair consideration.