Healthcare operations encompass various components, with one of the most critical being the submission of health insurance claim forms within the designated timely filing limits. Failing to adhere to this timeframe can hinder or completely halt the reimbursement process from insurance payers.
As a healthcare provider, your primary concern is delivering care to patients; however, receiving payment for that care is contingent upon prompt medical billing. When claims are submitted past the payer’s deadline, it frequently leads to delays in payment, an increase in claim denials, and additional administrative challenges.
The encouraging news is that maintaining compliance with timely filing requirements is quite feasible. Certain plans, including particular commercial payers or Medicare, may allow filing for a duration of up to one year or even longer.
This article aims to assist you in adhering to these deadlines. We will analyze the standard timely filing limits set by various payers, strategies to prevent submission errors, and suggestions to ensure your claim cycle remains on track.
By adopting the appropriate strategies, you can circumvent cutoffs and ensure a steady flow of reimbursements.
What Does Timely Filing Mean in Healthcare?
Timely filing in the healthcare sector pertains to the defined timeframe within which a healthcare provider is required to submit a health insurance claim to a payer (including Medicare, Medicaid, If claims are not submitted within this specified period, the insurance company is likely to reject the claim, resulting in the provider not receiving compensation for their services.
This principle also extends to the submission of appeals for any claims that have been denied. In certain instances, insurance companies enforce identical timely filing limits for both initial claims and subsequent appeals.
| Example: consider a scenario where a physical therapist provides treatment to a patient insured by XYZ Insurance on February 10th. Should the claim be submitted after this deadline, such as on June 20th, XYZ Insurance has the authority to reject the claim, resulting in the therapist not receiving payment. Likewise, if the insurance company denies the claim after it has been submitted within the appropriate timeframe, the therapist may only have a limited period, such as 120 days, to file an appeal contesting the denial. |
Timely Filing Limits: 2024 Overview
In the year 2024, the timely filing limits differed among Medicare, Medicaid, and various commercial payers:
Payer |
Timely Filing Limit (2024)
|
Medicare | 365 days from the date of service. |
Medicaid | The duration varies depending on the state; it generally falls between 90 days and 1 year. |
Aetna | A period of 120 days is applicable to the majority of commercial plans; however, for certain employer-sponsored and Medicare Advantage plans, the duration ranges from 180 days to 1 year. |
Cigna | 90 Days for providers who participate; 180 days for those who do not participate. |
United Healthcare (UHC) | 90 Days for providers who participate; 180 days for those who do not participate. |
Humana | 90 days from the date of service. |
Blue Cross Blue Shield (BCBS) | The duration varies by state; for instance, it is 180 days in Montana and 1 year in New York. |
Changes in 2025
As of 2025, numerous payers have updated their deadlines for timely filing. Healthcare providers must be informed of these modifications to prevent claim denials. Presented below is a detailed summary of the deadlines for timely submissions for the year 2025:
- Medicare: Remains at 12 Months
Medicare continues to require that claims be submitted within 12 months (365 days) from the date of service. This policy remains consistent with prior years.
- Medicaid: Variations by State
The deadlines for submitting timely filings to Medicaid differ across various states. For example, the Ohio Department of Medicaid has extended its filing deadline to March 1, 2025, to assist providers who are encountering contract difficulties. It is recommended that providers consult their individual state Medicaid programs to confirm the current filing deadlines.
Commercial Payers: Revised Deadlines
Commercial insurance providers have made the following adjustments to their timely filing limits for the year 2025:
- Aetna: Most commercial plans typically last for 120 days; however, some employer-sponsored and Medicare Advantage plans can extend their duration from 180 days up to 1 year.
- Cigna: Most commercial plans allow for a duration of 90 to 180 days; some employer-sponsored plans may extend up to 1 year.
- United Healthcare (UHC): Commercial plans typically range from 90 to 180 days; Medicare Advantage and employer-sponsored plans can extend up to 1 year.
- Humana: 90 days from the date of service.
- Blue Cross Blue Shield (BCBS): Deadlines differ by state; providers are advised to verify specific deadlines with their local BCBS office.
Timely Filing Limits: Overview for 2025
The table below provides a summary of the timely filing limits for 2025:
Medicare vs. Medicaid vs. Commercial Payers (2025)
Payer | Filing Deadline (2025) | Key Notes |
Medicare timely filing limit | 365 days from the date of service | No change from 2024 |
Timely Filing Limit of Medicaid | 90 days to 12 months, state-specific | Ohio has been extended until March 1, 2025, for certain providers. |
Aetna | A duration of 120 days is applicable for the majority of plans; whereas, Medicare Advantage and employer plans may extend up to 1 year. | Confirm plan type before assuming the deadline. |
Cigna | 90–180 days; some plans allow 1 year | Varies depending on provider contract |
United Healthcare | 90 days from the date of service | Check employer plan documentation for specific limits. |
Humana | 180 days to 12 months | Stays uniform for both commercial and Medicare Advantage plans |
BCBS (state-specific) | Generally spanning a period of 12 to 15 months from the date of service. | Example: 180 days in Montana, 1 year in New York |
Timely Filing Limit of BCBS by State
Verify the deadlines for claim submissions pertaining to BCBS plans in different states using our straightforward guide. Remain proactive by confirming that all claims are submitted within the necessary timeframes to facilitate seamless reimbursement processing.
State | BCBS Timely Filing Limit |
| Alabama | 2 Years |
| Alaska | 1 Year |
| Arizona | 1 Year |
| Arkansas | 180 Days |
| California | 180 Days |
| Colorado | 1 Year |
| Delaware | 120 Days |
| Florida | 1 Year |
| Hawaii | 1 Year |
| Idaho | 180 Days |
| Illinois | 180 Days |
| Indiana | 90 Days |
| Iowa | 180 Days |
| Kansas | 12 Months |
| Kentucky | 90 Days |
| Louisiana | 15 Months |
| Massachusetts | 90 Days |
| Michigan | 1 Year |
| Minnesota | 180 Days |
| Mississippi | December 31 of the following year |
| Montana | 180 Days |
| Nebraska | Varies by plan |
| New Jersey | 180 Days |
| New Mexico | 180 Days |
| New York | 1 Year |
| North Carolina | 18 Months |
| Ohio | 90 Days |
| Oklahoma | 180 Days |
| Pennsylvania | 1 Year |
| Rhode Island | 180 Days |
| South Dakota | 180 Days |
Timely Filing Guidelines for Claims Submission and Adjustments
The following outlines the deadlines for submitting original, corrected, adjusted, and coordinated benefits (COB) claims across various insurance plans. Each program has designated timeframes that providers are required to adhere to in order to guarantee that claims are processed and reimbursed correctly.
Badger Care
- Claims for Correction or Adjustment: These claims may be submitted within 365 days from the DOS or within 60 days after the payment, denial, or rejection of the original claim, depending on which event occurs later.
- Important Notice (Effective January 1, 2025): In cases where Coordination of Benefits (COB) is relevant, it is essential for providers to attach documentation to the secondary claim that confirms the claim was filed with the other insurer within Security Health Plan’s 365-day filing window from the date of service.
Commercial Plans
Original Claim Submission:
- Affiliated Providers: Submissions must be made within 180 days from the Date of Submission (DOS).
- Non-affiliated Providers: Submissions are required to be completed within 15 months from the Date of Submission (DOS).
Family Health Center
Please consult your specific FHC agreement for any deviations from the timelines outlined below.
Correction or Adjustment Claims:
These submissions are required to be made within 60 days after the date of the statement for the latest claim received during the initial claim submission period.
Coordination of Benefits (COB):
COB claims are required to be submitted within 60 days following the primary payer’s statement or within the period of the original claim submission, based on which deadline is later.
Medicare Advantage HMO/POS and Medicare Advantage
Each adheres to specific deadlines for the submission of initial claims, corrections, and COB documentation to guarantee timely processing.
Initial Claim Submission | All providers are given a period of 365 days from the date of service to submit their initial claim. |
Claims for Correction or Adjustment | Claims may be submitted within 365 days from the date of service or within 60 days following the payment, denial, or rejection of the initial claim, whichever period is longer. |
Coordination of Benefits (COB) | Providers are permitted to submit COB claims either within 365 days from the date of service or within 60 days from the date of the other payer’s statement, depending on which of these deadlines occurs later. |
Medicare Select-Senior Security
Original Claim Submission | Providers are required to submit their original claims within 180 days from the date of service. |
Correction or Adjustment Claims | Claims of this nature may be submitted within 180 days from the date of service or within 60 days following the payment, denial, or rejection of the initial claim, depending on which event occurs later. |
Coordination of Benefits (COB) | COB claims must be submitted within 180 days from the date of service or within 60 days from the date of the other payer’s statement, whichever deadline occurs later. |
Insite by Security Health Plan
These timelines are structured to guarantee that both affiliated and non-affiliated providers adhere to their contractual filing limits, thereby facilitating accurate and timely reimbursement.
Original Claim Submission:
For All Groups:
Affiliated Providers | Claims should be submitted within 180 days from the date of service.
|
Non-affiliated Providers | The group’s Specific Policy Details (SPD) indicate a filing window of either 12 or 15 months.
|
Correction or Adjustment Claims:
For All Groups:
- Affiliated Providers: Have a period of 180 days from the date of service or 60 days from when the claim was paid, denied, or rejected, depending on which deadline occurs later.
- Non-affiliated Providers: Are required to follow the same 12 or 15-month timeline as outlined in the group’s Summary Plan Description (SPD).
Coordination of Benefits (COB):
For All Groups:
- Non-affiliated Providers: Must continue to follow the 12 or 15-month timeframe as specified by the group’s Summary Plan Description (SPD).
Importance of Adhering to Timely Filing Limits
Submitting claims within the designated deadlines guarantees that providers receive appropriate reimbursement for the services provided. Noncompliance with these limits may lead to claim denials, resulting in possible revenue loss and increased administrative challenges.
Providers ought to implement robust internal protocols to efficiently monitor and handle claim submissions. The use of electronic health record systems or practice management software with integrated billing capabilities can assist in monitoring deadlines and optimizing the submission process.
How to Provide Proof of Timely Filing?
Here are the steps to collect and present the necessary documentation to support your claim and prevent denials due to late submissions:
Use Clearinghouse Reports
Most clearinghouses generate a submission report or claim acknowledgment, often known as a 999 or 277CA file, which confirms the date on which the claim was submitted to the payer.
- Ensure that the date on the report falls within the payer’s timely filing limit.
- Retain both the submission batch report and the payer acknowledgment.
Save Payer Acknowledgments (ERA/EOBs)
Upon acceptance of the claim by the payer, they generally issue an Electronic Remittance Advice (ERA) or an Explanation of Benefits (EOB). These documents generally indicate:
- The date the claim was received
- The date it was processed
- The status of the claim
Even in instances of denial, the date received acts as evidence of prompt filing.
Submit Certified Mail Receipts (for Paper Claims)
If you are submitting paper claims:
- Dispatch them via certified mail, ensuring a return receipt is requested.
- Keep a copy of the sent claim, the mailing receipt, and the delivery confirmation.
Use Portal Submission Screenshots
If the payer’s portal permits claim submissions:
- Capture a screenshot of the final submission confirmation that displays the date and time.
- Preserve confirmation emails (if available).
Document Resubmissions Carefully
If you are resubmitting:
- Provide evidence of the initial submission (for instance, clearinghouse reports or mailing receipts).
- Enclose a cover letter stating that this is a corrected or resubmitted claim, and include the original claim number as a reference.
| Best Practice: Keep a Filing Log. Keep a record of submission dates for every claim internally and include the relevant evidence (such as batch report, clearinghouse acknowledgment, or mail tracking ID). |
If you are contesting a claim that was denied because of late submission, you may attach this documentation when you file your appeal.
Strategies for Managing Timely Filing
To efficiently oversee deadlines for timely submissions, healthcare providers may adopt the following strategies:
- Stay Informed
Consistently examine payer agreements and formal correspondence to stay informed about any modifications to submission deadlines.
- Use Billing Software with Alerts
An efficient practice management system can issue notifications as filing deadlines draw near. This guarantees that claims are not overlooked amidst daily operations.
- Create a Denial Log
Monitor all denied claims related to untimely filing. This assists in identifying patterns, whether delays originate from your team or are due to payer issues.
- Train Your Billing Staff
It is essential to keep the billing team updated regarding the timely filing limits for each payer. A mere 30-day discrepancy between two commercial plans can have a substantial impact on results.
- Document Everything
If you submit a claim close to the deadline, ensure you save confirmation receipts. Should a payer later assert that the claim was submitted late, you will possess evidence of timely submission.
- Use Clearinghouses Efficiently
Claims often go through clearinghouses before being received by the payer. Ensure that clearinghouses confirm the acceptance and prompt forwarding of a claim.
- Appeal When You Have Grounds
If a delay arises as a result of a system malfunction or a natural calamity, it is advisable to submit an appeal. Certain payers permit reconsideration when documentation substantiates your case.
What Happens If You Miss the Deadline?
Failure to comply with the timely filing deadline will result in the automatic denial of the claim by most payers. However, not all hope is lost. Here’s what you can do:
- Check for Exceptions
Certain payers offer grace periods under circumstances like payer system outages, disruptions caused by COVID-19, or challenges related to provider onboarding.
- Submit a Corrected Claim (if applicable)
If the initial claim was submitted punctually but included mistakes, you might still have the chance to amend and resubmit it.
- File a Reconsideration or Appeal
Provided you have a valid reason for the delay, some payers will consider your appeal especially if this was an isolated incident.
- Look Into Secondary Coverage
If the main payer rejects the claim because of late submission, you might still have the opportunity to bill a secondary insurance (like Medicaid), contingent upon the coordination of benefits regulations.
2025 Tips for Staying Compliant
The regulations regarding timely filing may seem simple; however, handling deadlines from different payers can become quite complex. Below are several tips tailored for 2025:
- Bookmark Official Updates
CMS and major commercial insurers frequently publish updates.
- Confirm Medicaid Deadlines at the State Level
Especially with changing regulations due to contract modifications and system updates (such as in Ohio), ensure that you check your state’s website directly.
- Inform Providers in Your Network
If you are part of a multi-specialty group or ACO, conduct brief 10-minute refreshers each quarter. A solitary late claim may lead to write-offs amounting to thousands of dollars.
- Establish Internal Filing Objectives
Do not postpone filing a Medicare claim until day 350. Set an internal target, perhaps 45 days from the date of service, for all claims, regardless of the payer.
- Cultivate Strong Payer Relationships
A brief email or phone conversation with your payer representative can clarify ambiguous policies. They are generally willing to assist if you reach out promptly.
Final Thoughts
Timely filing limits are not merely dates on a calendar; they are a vital aspect of compliance in medical billing. Failing to meet these deadlines can directly impact your revenue, disrupt cash flow, and result in compliance challenges. Medicare requires that claims be submitted within a 12-month period, while Medicaid deadlines vary by state, and commercial insurers frequently update their policies. Staying informed about these regulations is essential to secure proper reimbursement and avoid claim denials.
Even a single missed deadline can result in denied claims and dissatisfied staff. However, with the appropriate tools, processes, and awareness, providers can avert unnecessary losses and maintain a clean billing cycle.
Pro Tip: Develop a straightforward dashboard that outlines each payer, their filing limits, and the internal submission goal. Review it weekly.
Frequently Asked Questions
Q1. Where can I obtain the updated 2025 Medicare Redetermination Form?
You can download the 2025 Medicare Redetermination Request Form directly from the CMS website or the MAC (Medicare Administrative Contractor) portal relevant to your jurisdiction. Ensure you use the form labeled “CMS-20027” and verify that all sections are filled out correctly prior to submission. Starting in 2025, redetermination requests must be submitted within 120 days of the initial claim decision.
Q2. What is the EmblemHealth TFL (Timely Filing Limit) for claims in 2025?
The EmblemHealth TFL limit for claims remains at 180 days (6 months) from the date of service as of 2025. Claims submitted after this timeframe are generally denied unless there is evidence of prior submission or a legitimate exception (for instance, a delay in coordination of benefits). Always consult the most recent provider manual for any specific variations related to the plan.
Q3. What is WellMed’s timely filing limit for claims in 2025?
As of 2025, WellMed mandates that all initial claims be submitted within 90 days from the date of service. For corrected claims or appeals, the timely filing limit may differ based on the contract or state-specific regulations typically an additional 60 to 120 days from the date of denial.