Timely filing · fee-for-service (PROMISe)
Pennsylvania Medicaid timely filing limit
Short answer
The Pennsylvania Medicaid timely filing limit is 180 days: under 55 Pa. Code § 1101.68 an original fee-for-service claim has to be received by the Department of Human Services within 180 days after the date the service was rendered. A rejected original claim, or a claim adjustment, gets a second window and must be received within 365 days of the date of service.
Nursing facilities and ICF/MR providers count both limits from the last day of the billing period. A claim held past 180 days because eligibility or another insurer was still pending can go in as a 180-day exception request, but only if you asked within 60 days of the service. Compare other payers in the timely filing limits table.
Last reviewed by the Remitwright billing team. Editorial policy
The windows
- Initial claim
- 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 period1
- Counted from
- The date the service was rendered or the item was provided, to the date the Department receives the claim. Nursing facility and ICF/MR claims count from the last day of the billing period. Under a 180-day exception, the deadline for the request runs from the County Assistance Office's eligibility determination processing date or from the date on the other insurer's denial or approval.
- Appeal
- 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
- Corrected claim
- A resubmitted rejected claim or a claim adjustment must be received within 365 days of the date of service. For nursing facility and ICF/MR providers, a rejected original claim must be resubmitted within 365 days of the last day of each billing period.
- 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 180 days forward from a date of service of Monday, March 2, 2026 gives Saturday, August 29, 2026. 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
Eligibility was still being decided at the County Assistance Office
If you asked the County Assistance Office (CAO) for an eligibility determination within 60 days of the date of service, the Department will consider a 180-day exception. Your request has to reach the Department within 60 days of the CAO's eligibility determination processing date.
Another insurer was billed first
If you requested payment from a third party insurer within 60 days of the date of service, the Department will consider a 180-day exception. The request must be received within 60 days of the date printed on the third party's denial or approval.
Nursing facilities and ICF/MR providers
These providers do not count from each date of service. Original claims are due within 180 days of the last day of the billing period, and a rejected claim must be resubmitted within 365 days of the last day of that billing period.
What counts as proof of timely filing
- For a CAO delay, the dated eligibility notification and your correspondence to and from the County Assistance Office
- For a third party delay, the other insurer's explanation of benefits showing the date it denied or approved the claim
- A 180-Day Exception Request Detail Page, completed and sent with each exception request
- For a rejected claim you resubmit inside 365 days, the remittance advice showing the rejection and the claim's ICN, which you can pull up in the PROMISe Provider Claim Inquiry window
Notes for billers
- Watch the pends. Section 1101.68 says a claim that shows as a pend on a remittance advice and has not become an approved or rejected claim after an additional 45 days should be resubmitted immediately, and the DHS billing FAQ adds that a claim that never appears on a remittance advice within 45 days of submission should be resubmitted.
- Paper 180-day exception requests for inpatient and outpatient claims go to P.O. Box 8042, Harrisburg, PA 17105, Attention: 180-Day Exceptions. Long-term care requests go to the Office of Long-Term Living, Bureau of Provider Support, P.O. Box 8025, Harrisburg, PA 17105-8025.
- For a hearing request sent by first-class mail, the U.S. postmark on the envelope is the filing date; any other way, it is the date the Bureau of Hearings and Appeals receives it (55 Pa. Code § 41.32). DHS says Medical Assistance provider appeals filed after November 24, 2006 are governed by 55 Pa. Code Chapter 41.
- These limits apply to fee-for-service claims billed to PROMISe. A Physical HealthChoices plan, a county BH-MCO or a Community HealthChoices plan pays its own claims, and its filing limit is the one in that plan's provider agreement and manual.
FAQ
Questions about Pennsylvania Medicaid deadlines
What is the Pennsylvania Medicaid timely filing limit?
How long do I have to fix and resubmit a rejected PROMISe claim?
When does Pennsylvania grant a 180-day exception?
How do I appeal a Pennsylvania Medical Assistance decision?
Does the 180-day rule apply to HealthChoices plans?
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