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How timely filing limits work in medical billing
How filing limits work for Medicare, Medicaid and commercial payers, and what to keep on file in case a payer says your claim came in late.
2 minute readBy the Fieldstone Billing teamUpdated
A timely filing limit is the deadline for submitting a claim to a payer. If you miss it, the claim can be denied even if the care and the coding were perfect, and a timely filing denial is often contractual, which means you can’t bill the patient instead. If a commercial contract gives you 90 days and a claim sits unnoticed in a rejection report for three months, the visit happened and the note is fine, and you may still have no way of getting paid for it.
Limits by payer type
| Payer type | General rule | What to check |
|---|---|---|
| Medicare | One calendar year after the date of service, with limited exceptions | Exceptions, and your MAC’s guidance |
| Medicaid | Varies by state and plan | State manual and managed care plan rules |
| Medicare Advantage | Set by the plan and your contract | Your contract, as this may differ from traditional Medicare |
| Commercial | Set by your contract, and can be much shorter | Your payer contract and provider manual |
These are general rules. Always confirm the limit in your own contract or the payer’s current manual.
One claim can have several clocks
Filing, corrected claim and appeal limits are different, and they can each start from a different date.
- The initial filing limit is counted from the date of service or discharge.
- The corrected claim limit may be counted from the original payment date.
- The appeal limit is usually counted from the date of the denial.
Medicare generally allows 120 days from the date you receive an initial determination to request a redetermination.
Proving you filed on time
If a payer says you filed late, you’ll need evidence, so keep these:
- The clearinghouse acceptance report showing the payer received the claim
- The payer’s acknowledgment, where available
- Records of status calls, including the date and reference number
- Any correspondence about coverage changes or retroactive eligibility
Watch out for the difference between two reports that can look alike. A clearinghouse report showing only that the clearinghouse received your claim may not be enough, so look for the payer’s acceptance. On electronic claims that’s often a 277CA.
Common exceptions
Some payers allow exceptions for retroactive eligibility, coordination of benefits delays or payer errors. These are specific to each payer, so check their rules, and ask for an exception in writing. Picture a patient whose Medicaid is approved months after the visit and backdated to cover it. That’s the kind of case these exceptions exist for, but you’ll need the eligibility paperwork, and the payer will have its own deadline for asking.
Keeping on top of the dates
- List the filing, corrected claim and appeal limits for your top payers in one place.
- Bill quickly after the visit, so there’s time left for fixing problems.
- Clear rejections weekly, since the original clock keeps running.
- Sort your A/R by deadline as well as by age.
The A/R recovery playbook shows how to work older claims in a sensible order. If you think you have claims close to their limits, a free billing audit can help you find them.
