Timely filing · fee-for-service (NC Medicaid Direct)
North Carolina Medicaid timely filing limit
Short answer
The North Carolina Medicaid timely filing limit is 365 days: NC Medicaid Direct claims must be received by NCTracks within 365 days of the first date of service, and hospital inpatient and nursing facility claims within 365 days of the last date of service on the claim.
When Medicare or another insurer, a Medicare Advantage plan included, processed the claim first, you have 180 days from that payer's EOB posted date to file with Medicaid, whatever the service date. A claim filed inside the 365 days can be refiled for 18 months from the last remittance advice date. To contest a final adjudication, request a reconsideration review within 30 calendar days. Compare other payers in the timely filing limits table.
Last reviewed by the Remitwright billing team. Editorial policy
The windows
- Initial claim
- 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 claim1
- Counted from
- The first date of service on the claim, or the last date of service for hospital inpatient and nursing facility claims, to the day NCTracks receives the claim. For Medicare and other third-party claims, the EOB posted date from that payer. For refiling a claim that was filed on time, the date of the last remittance advice.
- Appeal
- 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)
- Corrected claim
- A claim that was first filed inside the 365 days can be refiled within 18 months of the last remittance advice date. When another insurer pays after Medicaid has paid, the void or replacement claim goes to NCTracks within 180 days of that insurer's EOB posted date.
- Verified
- , against the payer document in the sources
Your participation agreement can set a different window. Where the contract and the manual disagree, the contract applies.
A visit on Monday, March 2, 2026
Counting 365 days forward from a date of service of Monday, March 2, 2026 gives Tuesday, March 2, 2027. That is the last day to file under the first limit shown above; a claim filed after it is outside the window unless one of the exceptions below applies.
Exceptions the payer allows
Medicare or another insurer processed the claim first
You have 180 days from the Medicare or other third-party EOB posted date to file with Medicaid, regardless of the service date and whether that payer paid or denied. This covers commercial insurers and Medicare Part C Advantage plans. Send the part of the EOB that shows the CARC detail. A denial of a covered Medicare service is not overridden; correct it and resubmit it to Medicare.
Time limit override for a claim filed on time
A claim that met the 365-day limit can go back in as a new claim with no override when the recipient ID, NPI, service dates and total billed amount all match the original exactly. When they do not match, submit through the NCTracks Provider Portal with the override documentation and a delay reason; the December 2020 guide lists third-party processing delay (7) and an original claim rejected or denied for a reason other than the billing time limit (9).
A health plan recouped after a retroactive eligibility change
When an NC Medicaid Managed Care health plan takes back a paid claim because the member's eligibility was updated retroactively, submit the claim to NC Medicaid Direct within 180 days of the recoupment date, with proof of the recoupment and verification that the original claim was submitted on time.
Liability insurance cases
If you billed a liability insurer or attorney within 365 days of the service and made a bona fide, timely effort to collect, you have six months (180 days) from the insurer's denial letter or payment to file with Medicaid, with documentation of the partial payment or denial, even when that runs past the usual 365 days.
What counts as proof of timely filing
- Dated correspondence from the Division of Health Benefits or the NCTracks fiscal agent about the specific claim, dated within 365 days of the date of service
- A Medicare or other third-party explanation of benefits dated within 180 days of that payer's payment or denial
- A remittance advice showing the claim pending or denied for a reason other than the time limit
- For a managed care recoupment, the health plan's proof of the recoupment plus verification that the original claim was submitted on time
Notes for billers
- The billing date printed on the claim and a copy of your office ledger are not accepted as proof. The guide's reason: the date you sent a claim does not show that NCTracks received it inside the 365 days.
- An override claim that does not match the original is denied with an NCTracks EOB code: 00018 when there is no claim history to support the override, and 05103 when the override request arrives without its documentation. Since February 5, 2017 the Medicaid Resolution Inquiry Form is not needed when the override claim goes in through the NCTracks Provider Portal or a batch X12 transaction.
- A reconsideration review request is in writing, signed by the provider or a representative, with the provider's name, address and telephone number and the specific objection, mailed to Appeals, Division of Health Benefits, 2501 Mail Service Center, Raleigh, NC 27699-2501. If no request arrives within the 30 or 60 days, the Division's action becomes final (10A NCAC 22J .0102).
- These rules cover NC Medicaid Direct claims paid through NCTracks. Standard Plans have allowed 365 days for original and corrected claims since July 1, 2023, and Tailored Plans since July 1, 2024; claims for state-funded services through a Tailored Plan are due within 90 calendar days of the date of service.
- NC Medicaid runs checkwrites 50 weeks a year, with none in the week of June 30 or the week of Christmas, so check the NCTracks checkwrite schedule for cut-off dates near either week.
FAQ
Questions about North Carolina Medicaid deadlines
What is the North Carolina Medicaid timely filing limit?
How long after a Medicare or commercial EOB can I bill NC Medicaid?
Can I refile a denied claim after the 365 days are up?
What counts as proof for a time limit override?
A health plan recouped my payment because eligibility changed. Where does the claim go?
How long do I have to request a reconsideration review?
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