What happens if a claim is filed after the timely filing deadline without an exception?

• A. They are typically denied.
• B. It is automatically paid.
• C. It is forwarded to HR.
• D. It remains in the queue for 12 months.

Answer: (A)

When a claim is filed after the timely filing deadline and no exception applies, the payer will deny it. This deadline sets the window during which claims will be reviewed for payment, and without an approved extension, there is no basis for retroactive processing. The denial preserves the payer’s processing timelines and auditing controls. It isn’t automatically paid, it isn’t something that’s forwarded to HR, and it isn’t kept in a queue for a set period to wait for later review. In some cases, an exception or extension might be granted for circumstances like certain patient or provider issues, but absent that, denial is the expected outcome.