{"id":183292,"date":"2026-08-18T06:14:42","date_gmt":"2026-08-18T06:14:42","guid":{"rendered":"https:\/\/pabau.com\/?p=183292"},"modified":"2026-08-18T10:13:37","modified_gmt":"2026-08-18T10:13:37","slug":"timely-filing-limits","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/blog\/timely-filing-limits\/","title":{"rendered":"Timely filing limits by payer: Initial claims, corrected claims and appeals"},"content":{"rendered":"
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Key takeaways<\/h3>\n <\/div>\n
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A timely filing limit is the deadline by which a payer has to receive your claim, counted from the date of service.<\/p>\n <\/div>\n

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Medicare allows one calendar year. Commercial plans commonly land between 90 and 365 days, and many set the number in your contract instead.<\/p>\n <\/div>\n

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The clock stops when the payer receives a valid claim. A rejection is not a receipt, so the clock keeps running.<\/p>\n <\/div>\n

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Corrected claims and appeals carry their own deadlines, and the appeal window usually starts from the remittance date rather than the date of service.<\/p>\n <\/div>\n

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A CO-29 denial can be overturned, but only with dated proof that the payer received your claim on time.<\/p>\n <\/div>\n <\/div>\n <\/div>\n \n\n\n

A timely filing limit is the deadline by which a payer has to receive your claim. Miss it and the claim is finished. The payer returns adjustment code CO-29, \u00ab\u00a0the time limit for filing has expired<\/a>\u00ab\u00a0.<\/p>\n\n\n\n

The CO group code makes that balance a contractual obligation your practice absorbs. Most network contracts also bar you from billing the patient for it, so a late claim is a pure write-off in your revenue cycle<\/a>.<\/p>\n\n\n\n

The table below carries three deadlines for each payer: initial claims, corrected claims, and appeals. Every figure was checked against the payer’s own published policy in August 2026, with the source named in each row. Where a payer sets its limit by contract or by state, the cell says so rather than inventing a single number.<\/p>\n\n\n\n

Timely filing limits by payer<\/h2>\n\n\n\n

There is no single timely filing limit. Medicare allows one calendar year from the date of service. Medicaid programs run from 90 days to 12 months depending on the state. Those short windows bite hardest in specialties that bill Medicaid heavily, such as ADHD practices<\/a>.<\/p>\n\n\n\n

Commercial plans commonly land between 90 and 365 days, and Blue Cross Blue Shield, known as BCBS, sets its limits plan by plan. Several large payers publish no national figure at all, because the number lives in your participation agreement.<\/p>\n\n\n\n

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Payer<\/th>Initial claim<\/th>Corrected claim<\/th>Appeal<\/th>Source<\/th><\/tr><\/thead>
Medicare<\/b>
Part B, fee-for-service<\/td>		One calendar year after the date of service<\/td>Reopening within one year of the initial determination, for any reason<\/td>Redetermination within 120 days of receiving the initial determination<\/td>42 CFR 424.44<\/a>, 405.942<\/td><\/tr>\n
Medicaid<\/b>
federal ceiling<\/td>		12 months from the date of service. Every state must impose this limit, and many set a shorter one<\/td>Not set federally. Each state program publishes its own rule<\/td>Not set federally. Check your state’s provider manual<\/td>42 CFR 447.45(d)<\/a><\/td><\/tr>\n
Medicaid, Texas<\/b><\/td>95 days from each date of service. Inpatient claims run from the discharge date<\/td>Filed as an appeal to TMHP, inside the same 120-day window<\/td>120 days from the disposition date on the Remittance and Status Report<\/td>TMHP manual<\/td><\/tr>\n
Medicaid, New York<\/b><\/td>90 days from the date of service<\/td>60 days from the date of notification, for claims returned with errors<\/td>No separate window published. Everything must be finally submitted within two years<\/td>eMedNY guide<\/td><\/tr>\n
BCBS of Texas<\/b>
Blue Choice PPO<\/td>		365 days from the date of service<\/td>Same 365-day deadline as the original claim<\/td>Claim review within 180 days of the payment date or provider claim summary<\/td>BCBSTX PPO manual<\/td><\/tr>\n
BCBS of Texas<\/b>
HMO Blue Texas<\/td>		180 days from the date of service<\/td>Same 180-day deadline as the original claim<\/td>Claim review within 180 days of the payment date or provider claim summary<\/td>BCBSTX HMO manual<\/td><\/tr>\n
Anthem BCBS<\/b>
Virginia<\/td>		365 days from the date of service<\/td>12 months from the date on the original explanation of payment<\/td>Reconsideration within 12 months of that payment notice, then appeal within 180 days of the outcome<\/td>Anthem provider news<\/td><\/tr>\n
UnitedHealthcare<\/b><\/td>Set by your participation agreement and state rules. UnitedHealthcare’s own worked example uses 90 days<\/td>The same number of days as the initial claim, counted from the date of service<\/td>Reconsideration and appeal together within 12 months of the remittance date<\/td>2026 UHC guide<\/a><\/td><\/tr>\n
Cigna<\/b><\/td>90 days after the date of service in network. 180 days out of network<\/td>The original deadline applies, unless Cigna asked for the extra information<\/td>180 calendar days from the initial payment or denial decision<\/td>Cigna claim filing<\/a><\/td><\/tr>\n
Aetna<\/b><\/td>Set by your contract. Aetna publishes no national figure in its provider manual<\/td>Not published separately. Your contract’s filing window applies<\/td>Reconsideration within 180 calendar days of the claim decision, then appeal within 60 days<\/td>Aetna disputes<\/td><\/tr>\n
Humana<\/b><\/td>Commercial, 90 days from the date of service unless state law or your contract says otherwise. Medicare Advantage, one year<\/td>Not published nationally. Varies by plan and state<\/td>Commercial follows the policy or state law. Medicare Advantage out of network, 65 days from the denial<\/td>Humana claims<\/td><\/tr>\n
TRICARE<\/b><\/td>One year after the services are provided<\/td>A returned claim is due back the later of one year after service, or 90 days from the return<\/td>Reconsideration mailed within 90 days of the initial determination notice<\/td>32 CFR 199.7, 199.10<\/td><\/tr>\n<\/tbody><\/table>
Verified August 2026 against each payer’s own published policy, linked per row. Your contract can shorten any commercial figure here, so check it before relying on the table.<\/em><\/figcaption><\/figure>\n<\/div>\n\n\n\n

Two patterns are worth noticing. BCBS is not one payer, and the three Blue plans above range from 180 to 365 days. The number also moves inside a single payer. UnitedHealthcare’s Empire Plan supplement gives 120 days after the end of the year of service, while its main guide sends you to your agreement.<\/p>\n\n\n\n

How the filing clock works<\/h2>\n\n\n\n

The clock starts on the date of service and stops when the payer receives a valid claim. The words that matter are receives and valid. Sending a claim is not the event that counts, and payers measure the days between the service date and their own date stamp on receipt.<\/p>\n\n\n\n

Institutional claims are the exception. Medicare, BCBS of Texas, and Texas Medicaid all run the window from the discharge date instead. For a span of care, that means the \u00ab\u00a0through\u00a0\u00bb date of the statement period, not the first day of the stay.<\/p>\n\n\n\n

A rejected claim keeps the clock running.<\/strong> A claim stopped by your clearinghouse or by the payer’s front-end edits was never accepted for adjudication, so nothing has been filed. Those edits usually catch demographic errors and missed eligibility checks<\/a>.<\/p>\n\n\n\n

UnitedHealthcare states the point plainly. Rejected claims are not proof of timely filing. Fix the data and resubmit the same week, because a clean claim<\/a> is the only kind that stops the clock.<\/p>\n\n\n\n

Secondary claims get their own start date. Most payers run the window from the primary insurer’s remittance instead of the date of service. Practices that bill Medicare plus a supplement see this constantly, including pelvic health practices<\/a>.<\/p>\n\n\n\n

Cigna measures from the processing date on the primary’s explanation of benefits. BCBS of Texas allows its full 180 or 365 days from the date the other carrier responds. UnitedHealthcare gives at least 90 days from the primary’s payment or denial.<\/p>\n\n\n\n

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The three windows never share a start date. That is how a practice ends up inside the filing limit but out of time to appeal.<\/em><\/figcaption><\/figure>\n\n\n\n
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One more override sits on top of all of it. Your participation agreement can shorten any commercial deadline, and state law can lengthen it. Aetna and UnitedHealthcare both decline to publish a national number for exactly that reason. For those two, the authoritative answer is the contract in your filing cabinet.<\/p>\n\n\n\n

CO-29: How to appeal a late filing denial<\/h2>\n\n\n\n

Check whether the denial is correct before you write anything off, then appeal inside the payer’s appeal window with dated proof of receipt. Payers do get this wrong, usually when a claim was received on time but reprocessed later under a new claim number.<\/p>\n\n\n\n