Timely Filing Limit for Medicare vs. Medicaid vs. Commercial Payers
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