Reference · timely filing
Timely filing limits by payer
A timely filing limit is the window a payer gives you to submit a claim, counted from the date of service unless the manual says otherwise.
Miss it and the claim is denied with CO-29 and cannot be billed to the patient. The table lists the limits we have verified in each payer's own manual, with the link and the date we checked. Your contract can set a different window, so the contract wins where the two disagree.
Last reviewed by the Remitwright billing team. Editorial policy
Limits
| Source | |||||
|---|---|---|---|---|---|
| Ambetter | ACA marketplace (Illinois) | 180 calendar days from the date of service for participating providers; 90 calendar days for non-participating providers | 180 calendar days from the date of Ambetter's EOP for a request for reconsideration or a claim dispute; 90 calendar days for non-participating providers | Ambetter of Illinois (Celtic Insurance Company) | |
| Anthem Indiana Medicaid | Medicaid managed care (Indiana) | 90 calendar days from the date of service for participating and nonparticipating providers, counted from the last date of service on the claim to the day Anthem receives it | A claim dispute on the Provider Dispute Resolution Request form within 60 calendar days from the date on the EOB, then a formal claims appeal within 60 calendar days from the date on the dispute response | Anthem Blue Cross and Blue Shield, published by Indiana Health Coverage Programs | |
| BCBS Illinois | commercial PPO and POS | 180 days from the date of service for professional claims (PPO, Blue Choice PPO, Blue HPN, MyBlue Plus POS); facility claims by December 31 of the calendar year after the year of service | No day count in the 2026 Commercial Provider Manual or on the Claim Review Form. Request a claim review through Availity Dispute Claim or the Claim Review Form; the Explanation of Benefits carries the appeal rights and submission options. | Blue Cross and Blue Shield of Illinois | |
| BCBS Texas | commercial | 365 days from the date of service for Blue Choice PPO and Blue High Performance Network; 180 days from the date of service for the HMO plans (Blue Essentials, Blue Advantage HMO, Blue Premier, MyBlue Health) | 180 days following the check date, the Explanation of Payment date or the Provider Claim Summary date for a first-level claim review | Blue Cross and Blue Shield of Texas | |
| CareSource | Medicaid managed care (Indiana) | 90 calendar days from the date of service or discharge, for participating and out-of-network providers | 60 calendar days from the written claim determination to file a claim dispute, then 60 calendar days from the dispute decision to file an appeal | CareSource, published by Indiana Health Coverage Programs | |
| Cigna | commercial | 90 days from the date of service for participating providers; 180 days for out-of-network providers | 180 calendar days from the date of the initial payment or denial notice, or from the date of the last payment adjustment | Cigna Healthcare | |
| Florida Blue | commercial (Blue Cross and Blue Shield of Florida) | 180 days from the date of service for every claim submission; the time in your participating provider agreement governs unless a law requires a longer period | One year from the date on the remittance advice, starting with a Provider Reconsideration on Florida Blue's Provider Reconsideration/Administrative Appeal Form | Florida Blue | |
| Florida Medicaid | SMMC plans and fee-for-service | No later than 12 months from the date of service, the outer limit 42 CFR 447.45 sets for every state Medicaid agency, Florida's included; claims to SMMC plans also fall under Florida's 6-month claims statute and the plan's own window | Set by each SMMC plan. At Sunshine Health, a reconsideration or claim dispute within 90 days of the explanation of payment for participating providers and 180 days for non-participating providers. | U.S. Government Publishing Office (govinfo) | |
| Georgia Medicaid | Georgia Families CMOs | Six months from the date of service at Peach State Health Plan, a Georgia Families CMO; a claim the plan receives after that is denied for failure to file timely | A claim appeal on Peach State's Provider Appeal Request Form, filed no more than 30 calendar days past the denial date. After the internal appeal, 15 business days from receipt of the plan's decision to request an administrative law hearing, or choose binding arbitration instead. | Peach State Health Plan | |
| Highmark Delaware | commercial (Highmark BCBSD, Delaware) | 180 days from the date of service at minimum, in or out of network, under Delaware law; your Highmark agreement can allow longer | The Delaware statutes and regulations cited here do not set an internal appeal window for Highmark; check your Highmark agreement and provider manual for one. After Highmark's final reimbursement decision, you have 60 days from receipt to petition the Delaware Insurance Department for arbitration. | Delaware General Assembly | |
| Horizon BCBSNJ | commercial (Horizon Blue Cross Blue Shield of New Jersey) | 180 days from the last date of service under New Jersey's claims rule (N.J.A.C. 11:22-3.4), for a claim filed on the patient's assignment of benefits | On or before the 90th calendar day after you receive Horizon's claims determination, under the ETPAA internal appeal rule that applies to New Jersey carriers | New Jersey Department of Banking and Insurance | |
| Humana | commercial and Medicare Advantage | One year from the date of service for Medicare Advantage unless the agreement or state or federal law sets another period; commercial plans follow the participation agreement | 18 months from the date the claim was paid to request a claim dispute or reopening, unless law or your agreement sets another period | Humana | |
| Illinois Medicaid | fee-for-service (HFS) | 180 days from the date of service; for hospital inpatient claims, 180 days from the date of discharge | HFS pays a rejected service only on a corrected claim that reaches it within 180 days of the date of service or within an exception period, and an override request that fails the criteria shows as a timely filing rejection on the remittance advice. A paid claim can be replaced or voided within 12 months of the original paid voucher date. | Illinois Department of Healthcare and Family Services | |
| Kaiser Permanente | California HMO | 90 calendar days from the date of service or discharge (Northern and Southern California), unless your agreement or the law sets a different period | 365 calendar days from KP's action on the claim (the most recent one, if there were several), or from the end of KP's time to contest or deny when it took no action | Kaiser Foundation Health Plan, Inc. | |
| Medi-Cal | California Medicaid | Six months following the month of service, with payment cut to 75 percent in months 7 to 9, 50 percent in months 10 to 12 and nothing after month 12 | Set by each Medi-Cal managed care plan: 365 days from the plan's action for a provider dispute at San Francisco Health Plan, six months from the initial EOP at CenCal Health | San Francisco Health Plan (Medi-Cal managed care plan) | |
| Medicare | Part B, original Medicare | 12 months (one calendar year) from the date of service | 120 days from receipt of the remittance advice or MSN to request a redetermination (receipt is presumed 5 days after the notice date) | CMS | |
| Molina Healthcare of Iowa | Medicaid managed care (Iowa) | 180 calendar days from the date of service for in-network outpatient claims, or from discharge for inpatient stays; 365 calendar days for out-of-network providers | 180 days from the date on the EOP or provider remittance advice for a first-level claim dispute, then 30 days from that decision for a second-level dispute | Molina Healthcare of Iowa, published by Iowa HHS | |
| New Jersey Medicaid | fee-for-service (NJMMIS) | One year from the date of service for claims received by the New Jersey Medicaid fiscal agent; one year from discharge on an inpatient hospital claim; 30 days from the service for EPSDT and pediatric HealthStart claims | A written fair hearing request within 20 days of the date in the right-hand corner of the Remittance Advice Claims Status page that shows the denial or payment adjustment. The fair hearing route excludes HMO claims processing and HMO-provider contract issues. | New Jersey Department of Human Services, Division of Medical Assistance and Health Services | |
| New York Medicaid | fee-for-service (eMedNY) | 90 days from the date of service, unless the delay was outside your control; every claim must also be finally submitted and payable within two years of the date of service | No appeal process when a claim carrying a delay reason code is denied. For a claim over two years old denied under edit 01292, a written review request with supporting documentation must reach the Department within 60 days of the date on the remittance. | eMedNY, New York State Department of Health | |
| North Carolina Medicaid | fee-for-service (NC Medicaid Direct) | 365 days from the first date of service for claims received by NCTracks; hospital inpatient and nursing facility claims, 365 days from the last date of service on the claim | 30 calendar days from receipt of the final notification of payment, payment denial, disallowance or payment adjustment to request a reconsideration review (60 days for a notice of an institutional reimbursement rate) | NC Medicaid, NC Department of Health and Human Services | |
| Ohio Medicaid | fee-for-service and MCOs (ODM) | 365 days from the date of service, for fee-for-service claims and for claims billed to Ohio Medicaid managed care organizations | At an MCO, a claim dispute within 12 months from the date of service or 60 calendar days after the payment, denial or partial denial of a timely claim, whichever is later. For a medical necessity denial, external medical review within 30 calendar days of the MCO's appeal decision or dispute resolution. | Ohio Department of Medicaid | |
| Oscar Health | commercial, Texas | 95 days from the last date of service for out-of-network providers in Texas; in-network providers follow the timely filing deadline in their Oscar agreement | 365 days from receipt of the Explanation of Payment in Texas and Florida (180 days in other states), unless your agreement sets another timeline | Oscar Health | |
| Pennsylvania Medicaid | fee-for-service (PROMISe) | 180 days from the date of service for an original claim to be received by the Department; nursing facility and ICF/MR providers count the 180 days from the last day of the billing period | A request for hearing filed with the DHS Bureau of Hearings and Appeals within 33 days of the date of the written notice of agency action when the notice was mailed, or within 30 days when it was delivered another way | Pennsylvania Code and Bulletin (Legislative Reference Bureau) | |
| Texas Medicaid | fee-for-service (TMHP) | 95 days from each date of service; for inpatient claims, 95 days from the discharge date or the last date of service on the claim | 120 days from the disposition date on the Remittance and Status (R&S) Report for an appeal or adjustment request to TMHP | Texas Medicaid & Healthcare Partnership (TMHP) | |
| TRICARE | military health plan | One year from the date of service, or one year from the date of discharge for inpatient care (three years for care received overseas) | 90 days from the date on the explanation of benefits or other decision to file an appeal with the regional contractor | TRICARE (Defense Health Agency) | |
| UnitedHealthcare | commercial | Per your participation agreement and state law; at least 90 days from the date of service for participating providers where the capitation and delegation supplement applies | 12 months from the date of the original EOB or PRA, covering both the reconsideration and the appeal | UnitedHealthcare | |
| VA Community Care | federal (VA Community Care Network) | 180 calendar days from the date of service for outpatient care, or from the date of discharge for inpatient care | 90 calendar days from the date of denial to file a reconsideration request with Optum for Regions 1 to 3 | Optum | |
| Wellcare | Medicare Advantage | 180 calendar days from the date of service, or from the discharge date for inpatient services; 95 days for participating providers with Texas health plans | 90 calendar days from the date on the EOP for a claim payment dispute, or as your contract specifies; 90 calendar days from the claim denial or utilization review decision for a provider appeal | Wellcare |
No payer in this table matches. The table covers Ambetter, Anthem Indiana Medicaid, BCBS Illinois, BCBS Texas, CareSource, Cigna, Florida Blue, Florida Medicaid, Georgia Medicaid, Highmark Delaware, Horizon BCBSNJ, Humana, Illinois Medicaid, Kaiser Permanente, Medi-Cal, Medicare, Molina Healthcare of Iowa, New Jersey Medicaid, New York Medicaid, North Carolina Medicaid, Ohio Medicaid, Oscar Health, Pennsylvania Medicaid, Texas Medicaid, TRICARE, UnitedHealthcare, VA Community Care and Wellcare.
Limits change when manuals are revised. Each payer page explains what the limit is counted from, the exceptions the payer allows and what counts as proof of timely filing. If your contract sets a different window, follow the contract.
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