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The one-year-back rule, for providers

The one-year-back rule quietly erases more provider revenue than any denial. A charge that is not sued on, or kept alive by a pending claim, within a year of the date of service is usually gone.

Unpaid PIP balances at your practice? Request a provider claims review or call 313.733.1204.

On this page
  1. The rule
  2. Tolling after the 2019 reform
  3. Assignments and the clock
  4. Keeping balances collectable

The rule

MCL 500.3145 bars recovery of PIP benefits for any part of a loss incurred more than one year before the date the lawsuit is filed. The rule applies to providers just as it applies to patients.

Tolling after the 2019 reform

The amended statute pauses the one-year period from the date a specific claim for payment is made to the insurer until the insurer formally denies that claim. Two practical consequences follow:

  • A bill that was submitted properly and never formally denied may be more collectable than its date suggests.
  • A formal denial starts the clock running again from where it paused, so denials need to be tracked by date, not filed away. Tolling also requires the claim to be pursued with reasonable diligence.

Assignments and the clock

A provider that sues on a patient assignment generally takes only the rights the patient had on the date of the assignment, and an assignment covers benefits that were already incurred, not future treatment. For treatment after June 11, 2019, the provider’s direct claim under MCL 500.3112 is usually the cleaner route, but the timing rules still apply to it.

Keeping balances collectable

  1. Submit every bill with the records the insurer needs to treat it as reasonable proof.
  2. Log every formal denial with its date.
  3. Review your no-fault aging monthly, by date of service, not date of billing.
  4. File suit before the oldest open dates of service reach twelve months, net of any tolling.

Start with totals. Use the form below or call. Once a secure transfer is set up, send your aging report and we will flag the balances closest to expiring and file on them first.

Request a provider claims review

To start, we need your name, your practice and a phone number; a rough unpaid balance helps if you have it. Patient-level data comes later, through a secure transfer we set up with you, so please leave patient details out of this form.

Prefer to talk now? Call 313.733.1204.

Justin Grove, Michigan attorney since 2007 (P71253). One office: Woodward Avenue, Bloomfield Hills.

  1. Send totals. Your practice, a contact and a rough balance. No patient information.
  2. We set up a secure transfer. You can ask about a business associate agreement before sending claim data.
  3. You get a written summary by insurer. Which balances look collectable and which deadlines are closest. Then you decide.

Paid $64 a test. Settled at $2,500 or more Per-test amounts across one provider’s claims; what is owed depends on the service, codes and fee schedule.

The claims review is free from $3,000 in total open balances.

Example: 313-555-0147

Reviews start at $3,000 in total open balances. A rough total is enough.

Add a note (optional) anything we should know

Totals only, please: no patient names, dates of birth or records. We arrange a secure transfer for claim data after the first call.

Sending this request does not make you a client of the firm. If a deadline is close, call.

Call 313.733.1204Provider claims review