Timely filing · fee-for-service (TMHP)
Texas Medicaid timely filing limit
Short answer
The Texas Medicaid timely filing limit is 95 days from each date of service, measured to the day TMHP receives the claim; inpatient claims count from the discharge date or the last date of service on the claim. Behind it sits the federal limit: every claim must be initially filed with TMHP within 365 days of the date of service, regardless of enrollment status or retroactive eligibility.
When Medicare or another payer is primary, the 95 days run from its disposition date. Appeals of denied claims and adjustment requests on paid claims must reach TMHP within 120 days of the disposition date on the Remittance and Status (R&S) Report; a second-level appeal to HHSC gets another 120 days. Compare other payers in the timely filing limits table.
Last reviewed by the Remitwright billing team. Editorial policy
The windows
- Initial claim
- 95 days from each date of service; for inpatient claims, 95 days from the discharge date or the last date of service on the claim1
- Counted from
- Each date of service, or the discharge date or last date of service for inpatient claims, to the date TMHP receives the claim. For clients with Medicare or other insurance, 95 days from the other payer's disposition date. All claims must also be initially filed within 365 days of the date of service.
- Appeal
- 120 days from the disposition date on the Remittance and Status (R&S) Report for an appeal or adjustment request to TMHP
- Corrected claim
- Corrections to denied or paid claims are submitted as appeals or adjustment requests within 120 days of the R&S Report disposition 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 95 days forward from a date of service of Monday, March 2, 2026 gives Friday, June 5, 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
Retroactive eligibility
Claims for clients who receive retroactive eligibility, or who had no Medicaid number at the time of service, must be received within 95 days of the date the client's eligibility was added to the TMHP eligibility file (the add date) and within 365 days of the date of service.
Newly enrolled providers and enrollment changes
Claims from newly enrolled providers must be received within 95 days of the date enrollment is complete and within 365 days of the date of service. A provider whose taxonomy and benefit code changes gets 95 days from the date the new code is issued, inside the same 365 days.
Medicare or other insurance is primary
When Medicare and Medicaid both cover the service, TMHP must receive the claim within 95 days of the Medicare disposition date. When another third party was billed first, the 95 days run from that entity's disposition. If the third party does not respond, allow 110 days to elapse before filing with TMHP; the 365-day federal limit still applies.
Out-of-state providers
TMHP must receive claims from out-of-state providers within 365 days from the date of service.
What counts as proof of timely filing
- A page from an R&S Report documenting a denial of the claim
- An electronic rejection report of the claim that includes the Medicaid recipient's name and date of service
- For claims submitted electronically, a copy of the electronic claims report showing the client name or Medicaid identification number (PCN), the date of service, the total charges and the batch identification number (Batch ID)
- A TMHP rejection report, as proof of meeting the 365-day federal filing deadline
- Certification receipts, as proof of meeting the 95-day or 120-day filing deadline
Notes for billers
- Section 6 of the manual states the federal rule plainly: all claims must be initially filed with TMHP within 365 days of the date of service, regardless of provider enrollment status or retroactive eligibility.
- A first-level appeal is the provider's initial administrative or medical appeal to TMHP. A second-level administrative appeal must be received by HHSC Claims Administrator Operations Management within 120 days from the date of disposition by TMHP or the claims processing entity.
- The Texas Medicaid Provider Procedures Manual is reissued monthly. The October 2026 edition was updated on September 30, 2026 and contains policy changes through October 1, 2026.
- These rules cover fee-for-service claims processed by TMHP. Managed care organizations (STAR, STAR+PLUS, STAR Kids, CHIP) publish their own filing limits in their provider manuals.
FAQ
Questions about Texas Medicaid deadlines
What is the Texas Medicaid timely filing limit?
How long do I have to appeal a Texas Medicaid denial?
What if Medicare or another insurer is primary?
The client's eligibility was added late. Do I still get 95 days?
What proves I filed on time with TMHP?
I am a newly enrolled Texas Medicaid provider. When does my clock start?
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