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Payers and deadlines blog
Payer rules, filing windows, portals and the paperwork each one wants.
10 posts, newest first, from the Remitwright medical billing blog. Each one works through a hypothetical example and lists its sources.
Posts in Payers and deadlines
- Payers and deadlinesMedicare additional documentation requests (ADRs): the 45-day clock, who is asking and what to sendA Medicare additional documentation request response has a deadline set by who asks: MAC, RAC, SMRC, CERT or UPIC. What to send and how to track it.Updated Read
- Payers and deadlinesHow to read an ERA: the 835 segments a biller actually looks atHow to read an ERA: the 835 header, claim status, adjustments by group code with CARC and RARC, the PLB section and how to balance it to the deposit.Updated Read
- Payers and deadlinesMarketplace plans in 2026: fewer members, bigger deductibles and a 20% in-network denial rateHealthCare.gov insurers denied about a fifth of in-network claims in 2023, and enrollment fell in 2026. How to work ACA marketplace claim denials.Updated Read
- Payers and deadlinesMedicare Advantage denials: how often appeals win, and why so few are filedKFF found most appealed Medicare Advantage denials were overturned in 2024, yet few were appealed at all. What the appeal rate means for your queue.Updated Read
- Payers and deadlinesWhat the 2026 IDR operations rule changes for out-of-network claimsThe 2026 No Surprises Act IDR operations rule caps batch size and will move open negotiation into the federal portal. What changes for OON billing.Updated Read
- Payers and deadlinesPrior authorization decision deadlines in 2026: 72 hours, seven days and the reason a payer must now giveFrom January 1, 2026, Medicare Advantage, Medicaid and CHIP plans must meet federal prior authorization decision timeframes and give a specific reason.Updated Read
- Payers and deadlinesHow to track payer policy bulletins each month without missing an effective dateUnitedHealthcare re-keyed medical policies on October 1, 2026 and CMS posts NCCI edits every quarter. The monthly routine that catches each payer change.Updated Read
- Payers and deadlinesProof of timely filing: what counts, where to find it and how to present itWhat counts as proof of timely filing, where billers find it (acknowledgements, R&S pages, delay reason codes) and how to present the appeal.Updated Read
- Payers and deadlinesUnitedHealthcare's prior authorization reductions: the dates, who they cover and what to check on the claimUnitedHealthcare lists prior authorization reductions from November 1 and December 1, 2026 and Part B step therapy from January 1, 2027. What to verify.Updated Read
- Payers and deadlinesWISeR: prior authorization comes to traditional Medicare in six statesThe WISeR model runs January 1, 2026 to 2031 in six states, adding prior authorization or pre-payment review to skin substitutes and two more services.Updated Read