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

Healthcare operations involve several moving parts, but one of the most important is submitting the health insurance claim form within the allowed timely filing limits. Missing this window can slow or even stop the flow of reimbursements from insurance payers.

As a healthcare provider, your focus is on delivering patient care, but getting reimbursed for that care depends on timely medical billing. When claims are filed after the payer’s deadline, it often results in payment delays, increased claim denials, and added administrative burden.

The positive news is that staying compliant with timely filing requirements is entirely manageable. Most insurance plans offer a filing window ranging from 30 days to several months after the date of service. Some, like certain commercial payers or Medicare, may allow up to a year or more.

This article will guide you through meeting these deadlines. We’ll cover common timely filing limits across payers, how to avoid submission errors, and tips to keep your claim cycle on schedule.

With the right approach, you can avoid cutoffs and keep reimbursements flowing smoothly. 

What Does Timely Filing Mean in Healthcare?

Timely filing in healthcare refers to the specific time frame within which a healthcare provider must submit a health insurance claim to a payer (such as Medicare, Medicaid, or commercial insurance companies) after the date of service. If the claims are not submitted within this period, the insurance company will likely reject the claim, and the provider will not be compensated for their services.

This concept also applies to submitting appeals for any claims that have been denied. In some cases, insurance companies impose the same timely filing limits for both initial claims and subsequent appeals.

Example: Let’s say a physical therapist treats a patient covered by XYZ Insurance on February 10th. The insurer allows 120 days for submitting claims, so the therapist’s office must file the claim by June 10th. If the claim is submitted late, for example, on June 20th, XYZ Insurance can reject the claim, leaving the therapist without payment. Similarly, if the insurer denies the claim after it was filed on time, the therapist may only have a limited window, like 120 days, to submit an appeal challenging the denial.

Timely Filing Limits: 2024 Overview

In 2024, timely filing limits varied among Medicare, Medicaid, and commercial payers. The table below summarizes these deadlines:

Payer	Timely Filing Limit (2024)
Medicare	12 months (365 days) from the date of service.
Medicaid	Varies by state; generally ranges from 90 days to 1 year.
Aetna	120 days for most commercial plans; 180 days to 1 year for some employer-sponsored and Medicare Advantage plans.
Cigna	90 days for participating providers; 180 days for non-participating providers.
UnitedHealthcare (UHC)	90 days for participating providers; 180 days for non-participating providers.
Humana	90 days from the date of service.
Blue Cross Blue Shield (BCBS)	Varies by state; e.g., 180 days in Montana, 1 year in New York.

Changes in 2025

As of 2025, some payers have updated their timely filing limits. It’s essential for healthcare providers to be aware of these changes to avoid claim denials. Below is a detailed explanation of the 2025 timely filing limits:​

• Medicare: Unchanged at 12 Months

Medicare continues to require that claims be filed within 12 months (365 days) from the date of service. This policy remains consistent with previous years. ​

• Medicaid: State-Specific Variations

Medicaid’s timely filing limits still vary by state. For instance, the Ohio Department of Medicaid extended its filing deadline to March 1, 2025, to accommodate providers facing contract issues. Providers should consult their respective state Medicaid programs to confirm current filing deadlines.

Commercial Payers: Updated Deadlines

Commercial insurance companies have made the following updates to their timely filing limits for 2025:​

• Aetna: 120 days for most commercial plans; 180 days to 1 year for some employer-sponsored and Medicare Advantage plans. ​
• Cigna: 90 to 180 days for most commercial plans; some employer-sponsored plans allow up to 1 year. ​
• UnitedHealthcare (UHC): 90 to 180 days for commercial plans; up to 1 year for Medicare Advantage and employer-sponsored plans. ​
• Humana: 90 days from the date of service. ​
• Blue Cross Blue Shield (BCBS): Varies by state; providers should verify specific deadlines with their local BCBS office.

Timely Filing Limits: 2025 Overview

The table below summarizes the timely filing limits for 2025:

Medicare vs. Medicaid vs. Commercial Payers (2025)

Payer	Filing Deadline (2025)	Key Notes
Medicare timely filing limit	12 months (365 days) from date of service	No change from 2024
Timely Filing Limit of Medicaid	90 days to 12 months, state-specific	Ohio extended to March 1, 2025 (for some providers)
Aetna	120 days for most plans; up to 1 year for Medicare Advantage/employer plans	Confirm plan type before assuming deadline
Cigna	90–180 days; some plans allow 1 year	Varies depending on provider contract
UnitedHealthcare	90 days from date of service	Check employer plan documentation for specific limits
Humana	180 days to 12 months	Remains consistent for both commercial and Medicare Advantage plans
BCBS (state-specific)	Typically ranging from 12 to 15 months from the date of service.	Example: 180 days in MT, 1 year in NY

Timely Filing Limit of BCBS by State

Check claim submission deadlines for BCBS plans across various states with our easy-to-follow guide. Stay ahead by ensuring all claims are filed within the required timeframes for smooth 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 coordination of benefits (COB) claims across various insurance plans. Each program has specific timeframes that providers must follow to ensure claims are processed and reimbursed appropriately.

Badger Care

• Original Claim Submission:
  Providers must submit their initial claim within 365 days from the service date.
• Correction or Adjustment Claims:
  These claims can be filed within 365 days from the service date or within 60 days after the original claim’s payment, denial, or rejection—whichever occurs later.
• Coordination of Benefits (COB):
  Providers have the option to file COB claims either within 365 days from the service date or within 60 days following the issuance of the other payer’s statement, selecting whichever deadline comes later.
• Important Note (Effective January 1, 2025):
  When COB is involved, providers must include documentation with the secondary claim that verifies that the claim was submitted to the other insurer within Security Health Plan’s 365-day filing period from the service date. Any claim filed after this period will be denied.

Commercial Plans 

Here are the timely filing deadlines for commercial plans: 

Original Claim Submission:

• Affiliated Providers: Must submit within 180 days from the service date.
• Non-affiliated Providers: Must submit within 15 months from the service date.

Correction or Adjustment Claims:

• Affiliated Providers: Eligible to file corrections or adjustments within 180 days from the service date or within 60 days following payment, denial, or rejection of the original claim—whichever is later.
• Non-affiliated Providers: Must adhere to the 15-month submission window from the service date.

Coordination of Benefits (COB):

• Affiliated Providers: Can file COB claims within either 180 days from the service date or 180 days from the other payer’s statement—whichever deadline is later.
• Non-affiliated Providers: Must follow the 15-month submission period from the service date.

Family Health Center (Unless Otherwise Specified in Your FHC Agreement)

Please refer to your specific FHC agreement for any exceptions to the timelines listed below.

Original Claim Submission:

• Professional Claims: Must be submitted within 90 days from the service date.
• Facility Claims: Must be submitted within 180 days from the service date.

Correction or Adjustment Claims:
These must be filed within 60 days following the date of the statement for the most recent claim received during the original claim submission period.

Coordination of Benefits (COB):
COB claims should be submitted within 60 days from the primary payer’s statement or within the original claim submission period—whichever deadline is later.

Medicare Advantage HMO-POS and Medicare Advantage Ally Rx D-SNP

Each follows set deadlines for submitting initial claims, corrections, and COB documentation to ensure timely processing.

• Original Claim Submission:
  All providers have a 365-day window from the service date for the initial claim submission.
• Correction or Adjustment Claims:
  These can be filed within 365 days from the service date or within 60 days after the original claim’s payment, denial, or rejection—whichever is later.
• Coordination of Benefits (COB):
  Providers have the option to file COB claims within either 365 days from the service date or within 60 days from the issuance of the other payer’s statement, depending on which deadline is later.

Medicare Select-Senior Security

• Original Claim Submission:
  Providers must file their original claims within 180 days from the service date.
• Correction or Adjustment Claims:
  These claims are eligible to be submitted within 180 days from the service date or within 60 days after the original claim’s payment, denial, or rejection—whichever occurs later.
• Coordination of Benefits (COB):
  COB claims are accepted within 180 days from the service date or 60 days from when the other payer’s statement is issued, whichever deadline is later.

Medicare Supplement with Riders

• Original Claim Submission:
  All providers have 12 months from the service date to submit the original claim.
• Correction or Adjustment Claims:
  These must be submitted within the same 12-month period from the service date or within 60 days following payment, denial, or rejection of the initial claim—whichever is later.
• Coordination of Benefits (COB):
  Claims under COB should be filed within 12 months of the service date or within 12 months from the date Medicare issued the payment.

Insite by Security Health Plan

These timelines help ensure all affiliated and non-affiliated providers stay within their contractual filing limits for accurate and timely reimbursement.

Original Claim Submission:

• For All Groups:
  • Affiliated Providers: Must submit claims within 180 days from the service date.
  • Non-affiliated Providers: The filing window is either 12 or 15 months, determined by the group’s Specific Policy Details (SPD).

Correction or Adjustment Claims:

• For All Groups:
  • Affiliated Providers: Have 180 days from the service date or 60 days from when the claim was paid, denied, or rejected—whichever deadline comes later.
  • Non-affiliated Providers: Must follow the same 12 or 15-month timeline as specified by the group’s SPD.

Coordination of Benefits (COB):

• For All Groups:
  
  • Affiliated Providers: May file COB claims within 180 days from the service date or within 180 days from the payment, denial, or rejection date—choosing the later of the two.
  • Non-affiliated Providers: Continue to adhere to the 12 or 15-month timeframe as dictated by the group’s SPD.

Importance of Adhering to Timely Filing Limits

Timely filing is a critical aspect of the revenue cycle in healthcare. Submitting claims within the specified deadlines ensures that providers receive due reimbursement for services rendered. Failure to adhere to these limits can result in claim denials, leading to potential revenue loss and administrative burdens.​

Providers should implement robust internal processes to track and manage claim submissions effectively. Utilizing electronic health record or practice management systems with integrated billing functionalities can aid in monitoring deadlines and streamlining the submission process.

How to Provide Proof of Timely Filing? 

Here’s how you can gather and present the right documentation to support your claim and avoid denials due to late submissions:

Use Clearinghouse Reports

Most clearinghouses generate a submission report or claim acknowledgment (often called a 999 or 277CA file) that confirms the date the claim was transmitted to the payer. Save this report as proof.

• Make sure the date on the report is within the payer’s timely filing limit.
• Keep both the submission batch report and payer acknowledgment.

Save Payer Acknowledgments (ERA/EOBs)

If the payer accepts the claim, they usually issue an Electronic Remittance Advice (ERA) or Explanation of Benefits (EOB). These documents often show:

• Date claim was received
• Date processed
• Claim status

Even if denied, the received date helps establish proof of timely filing.

Submit Certified Mail Receipts (for Paper Claims)

If you submit paper claims:

• Send them via certified mail with return receipt requested.
• Keep a copy of the mailed claim, mailing receipt, and delivery confirmation.

Use Portal Submission Screenshots

If the payer’s portal allows claim submissions:

• Take a screenshot of the final submission confirmation showing the date and time.
• Save confirmation emails (if available).

Document Resubmissions Carefully

If you are resubmitting:

• Include original submission proof (like clearinghouse reports or mail receipts).
• Add a cover letter explaining it’s a corrected/resubmitted claim and reference the original claim number.

Best Practice: Keep a Filing Log Maintain an internal log of submission dates per claim and attach corresponding proof (batch report, clearinghouse acknowledgment, or mail tracking ID).

If you are dealing with a denied claim for late filing, you can include this documentation when you appeal. 

Strategies for Managing Timely Filing

To effectively manage timely filing limits, healthcare providers can adopt the following strategies:

1. Stay Informed

Regularly review payer contracts and official communications to stay updated on any changes to filing deadlines.

2. Use Billing Software with Alerts

A good practice management system can send alerts as filing deadlines approach. That way, claims don’t get buried in the day-to-day workflow.

3. Create a Denial Log

Track all denied claims related to untimely filing. This helps identify patterns—whether delays come from within your team or due to payer issues.

4. Train Your Billing Staff

Keep the billing team updated on each payer’s timely filing limits. Even a 30-day difference between two commercial plans can change outcomes.

5. Document Everything

If you submit a claim near the deadline, save confirmation receipts. If a payer later says the claim was late, you will have proof of timely submission.

6. Use Clearinghouses Efficiently

Claims often pass through clearinghouses before they reach the payer. Make sure clearinghouses confirm that a claim was accepted and forwarded promptly.

7. Appeal When You Have Grounds

If a delay was due to a system error or natural disaster, file an appeal. Some payers allow reconsideration when documentation supports your case.

What Happens If You Miss the Deadline?

If you miss the timely filing deadline, most payers will automatically deny the claim. But all hope isn’t lost. Here’s what you can do:

1. Check for Exceptions

Some payers offer grace periods in cases like payer system outages, COVID-19 disruptions, or provider onboarding issues.

2. Submit a Corrected Claim (if applicable)

If the original claim was submitted on time but had errors, you may still be able to correct and resubmit it.

3. File a Reconsideration or Appeal

As long as you have a valid reason for the delay, some payers will review your appeal—especially if this was a one-time issue.

4. Look Into Secondary Coverage

If the primary payer denies due to late filing, you might still bill a secondary insurance (like Medicaid) depending on coordination of benefits rules.

2025 Tips for Staying Compliant

The timely filing rules may seem simple, but juggling deadlines from multiple payers can get messy. Here are a few 2025-specific tips:

1. Bookmark Official Updates

CMS and large commercial insurers regularly post updates. Subscribe to newsletters or add reminders to check quarterly.

2. Verify Medicaid Deadlines at the State Level

Especially with shifting rules due to contract changes and system updates (like in Ohio), make sure to check your state’s site directly.

3. Educate Providers in Your Network

If you work in a multi-specialty group or ACO, hold quick 10-minute refreshers each quarter. One late claim can cause thousands in write-offs.

4. Set Internal Filing Goals

Don’t wait until day 350 to file a Medicare claim. Set an internal goal—say, 45 days from service—for all claims, no matter the payer.

5. Build Strong Payer Relationships

A quick email or phone call with your payer rep can clarify unclear policies. They are usually willing to help if you reach out in time.

Final Thoughts

Timely filing limits aren’t just dates on a calendar, they’re a critical part of compliance in medical billing. Missing these deadlines can directly affect your revenue, disrupt cash flow, and lead to compliance issues. Medicare requires claims within 12 months, Medicaid timelines vary by state, and commercial payers frequently update their policies. Staying up to date with these rules is essential to ensure proper reimbursement and avoid denials.

Even a single missed deadline can lead to denied claims and frustrated staff. But with the right tools, processes, and awareness, providers can avoid unnecessary losses and keep their billing cycle clean.

Pro Tip: Create a simple dashboard that lists each payer, their filing limits, and the internal goal for submission. Review it weekly.

References: 

https://provider.bluecrossma.com/ProviderHome/wcm/connect/4d9586ab-0bf0-4db4-b09f-cde68814a5ca/MPC_052218-1H_Timely_Filing_Guidelines.pdf?MOD=AJPERES

https://www.practicesol.com/single-post/everything-you-need-to-know-about-timely-filing-including-a-list-of-timely-filing-limits https://www.bcbstx.com/docs/provider/tx/standards/manuals/hmo-provider-manual/hmo-sec-f-a-general-info.pdf