Timely Filing Limits by Insurance

What is timely filing in medical billing?

Timely filing limits by insurance set how long a provider has to submit a claim after the date of service. Miss the window and the payer can deny the claim outright, usually with a timely filing denial, and in most network contracts the provider cannot bill the patient for the balance. That makes late filing one of the few billing errors with no clean recovery path.

So what is timely filing in medical billing in practice? It is a set of deadlines rather than one: the original claim limit, a limit for corrected claims, a limit for appeals and reconsiderations, and often a separate clock for secondary claims. Each payer, plan type and contract can set its own, and each one counts from a specific trigger date.

Timely filing limits by insurance: quick reference table

The table lists limits we confirmed in each payer's own public material. Where a payer's public pages leave the limit to the provider agreement, the table says so. Limits change and can differ by plan, product, state and contract, so confirm the current rule with the source in the last column before relying on it.

Payer	Original claim limit (as published)	Counted from	Where to confirm
Medicare (Original Medicare, Part B)	12 months (one calendar year)	Date of service (the "from" date on Part B claims)	CMS Medicare Claims Processing Manual, Chapter 1, Section 70; your MAC's timely filing page
Texas Medicaid fee-for-service (TMHP)	95 days for in-state providers	Each date of service	Texas Medicaid Provider Procedures Manual, Vol. 1, Section 6
Texas Medicaid managed care	Set by each MCO	Varies	The MCO's provider manual or quick reference guide
Superior HealthPlan (Texas Medicaid MCO)	95 days	Date of service	Superior HealthPlan provider quick reference guide
TRICARE (claims for care in the US)	1 year	Date of service or inpatient discharge	TRICARE claims FAQ and TRICARE Operations Manual, Chapter 8, Section 3
BCBS Texas (PPO)	365 days	Date of service	BCBSTX PPO Provider Manual, Filing Claims section
Cigna Healthcare	90 days participating; 180 days non-participating	Date of service	Cigna's "When to file claims" provider page and your agreement
Humana Medicare Advantage	1 year, unless the agreement or law says otherwise	Date of service	Humana provider manual for physicians, hospitals and other providers
Humana commercial	Not confirmed in public material we reviewed	–	Check your contract or provider manual
Aetna	Not confirmed in public material we reviewed	–	Check your contract or Aetna provider manual
UnitedHealthcare	Set by your participation agreement	Date of service	Your UnitedHealthcare participation agreement or contracting contact

A practical rule for any payer you cannot confirm: set your internal target well inside the shortest limit you see in your contracts. A practice that sends clean claims within a few days of the visit rarely has to look up a timely filing rule at all.

Timely filing limit for Medicare

The timely filing limit for Medicare is 12 months, or one calendar year, after the date of service. For Part B professional claims the "from" date of service starts the clock; for institutional Part A claims it is the "through" date. Medicare contractors note that a claim with a February 29 date of service must be filed by February 28 of the following year.

Only a claim Medicare actually processes counts as filed. A claim returned as unprocessable because information was missing or invalid does not stop the clock, so it must be corrected and resubmitted inside the same 12 months. Exceptions exist but are narrow and listed in the Medicare Claims Processing Manual, Chapter 1, Section 70; do not plan around them.

Medicare appeal deadlines

Appeals run on separate clocks. A Medicare redetermination must be requested within 120 days of receiving the initial determination, and a reconsideration by the Qualified Independent Contractor within 180 days of receiving the redetermination. Medicare Advantage plans set their own claim and appeal rules within federal requirements, so check the plan's provider manual.

Timely filing limit for Medicaid in Texas

The timely filing limit for Medicaid varies by state, and in Texas it also varies by who administers the benefit. For fee-for-service claims, the Texas Medicaid Provider Procedures Manual says TMHP must receive the claim within 95 days of each date of service for in-state providers. Out-of-state providers have a longer window.

Most Texas Medicaid clients are in managed care, and those claims go to the client's managed care organization, not TMHP. Only clients outside managed care and carved-out services are billed to TMHP. Each MCO publishes its own filing and appeal limits.

• Medicare and Medicaid dual eligibles: file with Medicare first. TMHP must receive the Medicaid claim within 95 days of the Medicare disposition date.
• TMHP appeals: must be received within 120 days of the disposition date on the Remittance and Status (R&S) Report where the claim appears.
• Superior HealthPlan timely filing: Superior's quick reference guide lists 95 days from the date of service for initial claims and 120 days from the date of the Explanation of Payment for corrected claims and reconsiderations.

Our Texas Medicaid billing guide covers enrollment, managed care and other TMHP rules in more depth.

TRICARE timely filing limit

The TRICARE timely filing limit for care received in the United States is one year from the date of service, or from the inpatient discharge date for facility stays. TRICARE's claims FAQ gives three years for care received overseas. The TRICARE Operations Manual, Chapter 8, Section 3, sets out the claims filing deadline rules and exceptions that apply to contractors.

TRICARE is a secondary payer to most other health insurance, so many TRICARE claims are filed after another plan has processed them. Keep the other plan's EOB with the claim and check the regional contractor's guidance on how secondary claims are timed.

Commercial payers: BCBS Texas, Cigna, Humana, Aetna and UnitedHealthcare

Commercial limits are usually written into the provider agreement, and the payer's manual applies when the agreement is silent. For self-funded employer plans the plan document can also matter. Use the published figures below as a starting point and confirm against your own contract.

BCBS Texas timely filing

For BCBS Texas timely filing, the BCBSTX PPO Provider Manual states that claims must be submitted within 365 days of the date of service. Corrected claims must follow the same filing deadline and carry the appropriate bill type. If BCBSTX asks for more information, the manual gives 90 days from the date of its request to resubmit. HMO, Medicare Advantage and Medicaid products have their own manuals, so check the one that matches the patient's plan.

Cigna timely filing limit

The Cigna timely filing limit on Cigna's provider site is 90 days after the date of service for participating providers and 180 days for non-participating providers. For consecutive-day services the limit counts from the last date of service. When Cigna is the secondary payer, timely filing counts from the processing date on the primary payer's EOB or explanation of payment. Cigna also lists exceptions, such as a longer period required by law or allowed by the provider agreement.

Humana timely filing limit

Humana's provider manual sets a Humana timely filing limit of one year from the date of service for its Medicare lines of business, unless the provider agreement or applicable law specifies otherwise, and refers Medicaid claims to the state-specific Medicaid manual. We did not find a commercial limit in the public manual we reviewed, so check your contract.

Aetna timely filing limit

We could not confirm a general Aetna timely filing limit for original claims in Aetna's public provider pages, so check your contract or the Aetna provider manual for your product. Aetna's disputes and appeals page does publish follow-up deadlines: a reconsideration must be filed within 180 calendar days of the initial claim decision, and an appeal within 60 calendar days of the reconsideration decision.

United Healthcare timely filing limit

UnitedHealthcare's provider site says the agreement sets the required number of days for submitting claims, including corrected claims, and points providers to their participation agreement or contracting contact. Treat the United Healthcare timely filing limit as a contract term and record it from your own agreement rather than from a general list.

State prompt pay rules in Texas

For fully insured HMO and PPO plans regulated in Texas, the Texas Insurance Code sets a 95-day submission deadline for physicians and providers, with limited exceptions. Self-funded ERISA plans are not subject to these state rules. See our Texas Prompt Pay Act guide for how the statute works.

Corrected claim timely filing

Corrected claim timely filing rules differ widely. Medicare treats a corrected or reopened claim under its reopening rules rather than as a new filing, and a claim that was rejected as unprocessable must still be resubmitted within the original 12 months. Some commercial plans, like BCBSTX, apply the original filing deadline to corrected claims; some Medicaid plans, like Superior HealthPlan, count from the date of the payment notice.

Because the clock may already be running from the date of service, send a corrected claim as soon as the error is found. Use the correct frequency code, reference the original claim number, and keep proof of submission. Our article on corrected claims vs appeals explains when a corrected claim is the right route.

Appeal timely filing limit

Every appeal timely filing limit counts from the payer's decision, not the date of service. That means two clocks run on a denied claim: the original filing window (relevant if you need to submit a new or corrected claim) and the appeal window (relevant if you dispute the decision).

Payer	Appeal or reconsideration deadline (as published)	Where to confirm
Medicare, first level (redetermination)	120 days from receipt of the initial determination	Medicare.gov and CMS appeals pages; your MAC
Medicare, second level (reconsideration)	180 days from receipt of the redetermination	CMS second level of appeal page
TMHP (Texas Medicaid fee-for-service)	120 days from the R&S Report disposition date	Texas Medicaid Provider Procedures Manual, Section 6
Superior HealthPlan	120 days from the Explanation of Payment for corrected claims and reconsiderations	Superior HealthPlan quick reference guide
Aetna	Reconsideration within 180 calendar days of the claim decision; appeal within 60 calendar days of the reconsideration decision	Aetna disputes and appeals overview
Other commercial payers	Varies by contract and plan	Check your contract/provider manual

If a claim was denied for timely filing but you sent it on time, an appeal with proof of timely submission is usually the remedy. Our guide to appealing a denied claim covers the letter and the evidence to attach.

Proving a claim was filed on time

Payers generally accept proof that the claim reached them, not proof that it left your system. Keep the right evidence for each submission method.

• Electronic claims: the clearinghouse acceptance report or the payer's 277CA claim acknowledgment showing the claim was accepted, with the date.
• Rejected then resubmitted: both the original rejection and the resubmission acceptance, plus a note of what was fixed.
• Paper claims: a dated copy of the claim and certified mail or courier tracking, where the payer accepts it.
• Secondary claims: the primary payer's EOB or remittance showing its processing date.

A clearinghouse acceptance is not always payer acceptance. Watch for payer-level rejections in the days after submission, because a claim that never reached the payer's system has not been filed.

How to prevent timely filing denials

1. Build a payer deadline table from your actual contracts, with original, corrected, appeal and secondary limits and the trigger date for each.
2. Submit claims within a few days of service. Most timely filing write-offs start as charges that were never entered or claims held for missing information.
3. Work rejections daily. A rejected claim has not been filed, so the deadline keeps running.
4. Run an unbilled and no-response report weekly, sorted by days remaining until the payer's limit rather than by date of service.
5. Verify coverage before the visit. Billing the wrong payer first is a common way to miss the right payer's deadline.
6. Escalate before the deadline, not after. Flag any claim within 30 days of its limit for same-week action.

Fastora's claims management team submits and tracks claims against each payer's filing window, with certified billing professionals working rejections and follow-up. If timely filing write-offs are showing up in your adjustments, a free medical billing audit can show where claims are stalling.

What is the timely filing limit for Medicare?

The timely filing limit for Medicare is 12 months (one calendar year) from the date of service. Claims filed after the deadline are denied with no appeal on timeliness — the only exceptions are narrow administrative-error or retroactive-entitlement situations. Commercial payer limits are usually much shorter, commonly 90–180 days.

Checklist

Print checklist

• List original, corrected, appeal and secondary limits for every contracted payer
• Note the trigger date for each limit (date of service, EOP date, decision date)
• Enter charges and submit claims within a few days of service
• Work clearinghouse and payer rejections every day
• Save acceptance reports or 277CA acknowledgments as proof of filing
• Review unbilled and no-response claims weekly by days remaining
• Escalate any claim within 30 days of its filing limit

Frequently asked questions