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I am a billing manager for a small billing service that handles PIP claims. I am being told by my collectors that medical claims from the physician that are not received by the insurance carriers with 30 days of service will be denied for timely filing. They state that it is a Florida Law. Can you verify if this information is correct?

The information you have is nearly correct, it is within 35 days not 30 days that the billings must be submitted. However if you send an "initiation of treatment" letter to the insurance company than you will have 75 days after the earliest date of service to postmark your bills to the insurer.

When dealing with Personal Injury Protection (PIP) billing in Florida you must correctly follow the process to be paid. Bills must be timely submitted on properly completed billing forms. All bills must have accurate codes in effect for the year the services were rendered.

The initial billing must be accompanied by a properly completed Disclosure & Acknowledgement Form, which is available for downloading off the FL Department of Financial Services site, and be signed by the patient or the patient's legal guardian.

You can read through Florida Statute 627.736 for more information on the PIP claim time limits since that is the FL law specific to PIP billings, claims, etc. The Florida insurance regulator site summarizes the billing requirements in this law by saying:

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Florida Statutes provide that with respect to any treatment or services, other than certain hospital and emergency services, the statement of charges furnished to the insurer by the provider may not include, and the insurer and the injured party are not required to pay, charges for treatment or services rendered more than 35 days before the postmark date of the statement, except for past due amounts previously billed on a timely basis, and except that, if the provider submits to the insurer a notice of initiation of treatment within 21 days after its first examination or treatment of the claimant, the statement may include charges for treatment or services rendered up to, but not more than, 75 days before the postmark date of the statement. The insured has a responsibility to furnish the provider with the correct name and address of the personal injury protection insurer. Failure to do so may result in delayed reimbursements to the provider.

Where your collectors may have heard 30 days from is that PIP benefits are overdue if not paid within 30 days after the insurer is provided written notice of a covered loss and of the total amount of the claim. So the insurer has 30 days to pay after being informed of the loss and has the bills submitted to them by their insured or their medical providers. Medical bills however must be submitted within 35 days of the date the service was rendered or within 75 days if an initiation of treatment letter was submitted to the insurer within 21 days after the first treatment of the insured.

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For more Florida insurance law information contact the Florida insurance regulator who can also give you more information on the PIP billing process and time limits on claims or submission of bills. This state agency should be able to clarify any questions or concerns you or your collectors have regarding PIP medical claims.

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This car insurance answer was last updated 10:16 PM Sep-04.
This Insurance Claims question was asked 12:25 PM August-20-2009.
Gina M. requested this car insurance help from CarInsurance.com experts.
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