Glossary
Retroactive Billing
Submitting claims for services dating back to a retro-effective date after enrollment is approved, where the payer permits it.
Retroactive billing lets a provider submit claims for services performed before final enrollment approval, reaching back to an effective date the payer has agreed to honor. Whether this is allowed, and how far back it extends, varies by payer and program, and some plans grant no retro period at all. When permitted, it recovers revenue earned during the gap between starting work and completing payer enrollment, but it depends entirely on the payer's rules.