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Timely Filing Limits by Payer: Medicare, Medicaid, Aetna, Cigna, UnitedHealthcare, BCBS and More

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In short

  • Medicare allows twelve months from the date of service. Commercial and Medicaid limits are shorter and set by contract or state rule, often ninety to one hundred eighty days.
  • The deadline counts to the date the payer receives an acceptable claim, not the date you sent one that was rejected.
  • Keep clearinghouse acceptance reports; they are the only proof that wins a timely filing appeal.

Why timely filing denials are the worst denial

Every other denial can, in principle, be fixed and resubmitted. A timely filing denial (CARC 29) cannot: the payer owes nothing, and because the service was covered, the patient cannot be billed for it either. It is pure write-off. The good news is that it is entirely preventable with a submission discipline and a rejection workflow.

Limits by payer type

The limits below are the common defaults for participating providers. Your contract, your state and the specific plan can differ; the contract and the payer’s provider manual are the final word.

Payer Typical limit for in-network claims Notes
Medicare (original) 12 months from the date of service Statutory; very few exceptions (administrative error, retroactive entitlement).
Medicare Advantage plans Set by contract, often 90 to 180 days Not the Medicare 12-month rule.
Medicaid (fee-for-service) Varies by state; New York Medicaid generally requires submission within 90 days of the date of service States publish exceptions for retroactive eligibility and third-party liability delays.
Medicaid managed care plans Set by contract, commonly 90 to 180 days Can be shorter than the state FFS rule.
Aetna Commonly 120 days for participating providers Contract governs.
Cigna Commonly 90 days in network; longer out of network Contract governs.
UnitedHealthcare Commonly 90 days for participating providers; some agreements differ Community Plan (Medicaid) products follow state and contract rules.
Blue Cross Blue Shield plans Varies by plan, commonly 90 days to one year Each state plan sets its own; host-plan rules apply to BlueCard claims.
Humana Commonly 90 to 180 days depending on product and contract Medicare Advantage products set their own.
Tricare One year from the date of service Regional contractor rules apply.
Workers’ compensation and no-fault (New York) Set by state regulation; no-fault bills are generally due within 45 days of service Strict and form-driven.

How the clock is counted

  • Start. Usually the date of service; for inpatient stays, often the discharge date.
  • Stop. The date the payer receives a claim it accepts into adjudication. A claim rejected at the clearinghouse or the payer’s front end for a format error was never “received.”
  • Secondary claims. Many payers count from the primary payer’s remittance date, not the date of service. Check the manual.
  • Corrected claims and appeals. Separate deadlines, usually measured from the original remittance.

What proves timely filing

Clearinghouse reports showing the claim was accepted by the payer (a 277CA acceptance, not just a 999 acknowledgment) within the limit; a payer rejection letter within the limit; a remittance showing the claim was processed and then reopened. A screenshot of your practice management system showing a “sent” date does not usually count. Keep acceptance reports for every batch, for as long as the contract’s audit period.

Appealing a CO-29 denial

  1. Pull the acceptance report that shows the original submission within the limit.
  2. If the original was rejected, document the rejection date and the resubmission chain.
  3. Submit a written appeal citing the contract’s timely filing provision, with the evidence attached.
  4. If eligibility was retroactive or the wrong payer was billed first in good faith, cite the payer’s published exception.

Preventing it

  • Submit charges within two or three business days of the visit.
  • Work clearinghouse rejections daily; a rejection sitting for a month is a deadline sitting for a month.
  • Run an unbilled-encounters report weekly for visits with no claim.
  • Track claims with no response at thirty days and chase the payer; “we never received it” is a common answer and you want to hear it early.

Filing discipline is a basic part of Core MB’s medical billing service: charges out within days, rejections worked the day they land, and open claims followed up on a schedule, with the denial codes tracked monthly.

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