Healthfirst Timely Filing Limit 2026: 180 Days for Claims, 90 for Reconsideration, 60 for Disputes

The Healthfirst timely filing limit is 180 calendar days from the date of service. Corrected claims share that clock. If you're a participating provider in one of Healthfirst's New York plans and a first-time claim arrives after day 180, Healthfirst won't pay it, however clean the coding looks.

Two more deadlines start after Healthfirst processes the claim. You get 90 calendar days from the paid date on the Explanation of Payment (EOP) to request a review and reconsideration. If that decision goes against you, there's a 60-day window from the date on the reconsideration letter to file a formal dispute.

Keep those two windows apart from the filing limit. They govern appeals, and they start from Healthfirst's paperwork instead of your date of service. Several payer directories and AI search answers blend all three numbers together, and a biller who trusts them can write off a claim that still had weeks left.

Healthfirst Timely Filing Limits at a Glance

Healthfirst runs six deadlines that billers run into, and two of them are filing limits. The other four cover reconsideration, disputes, records requests, and Medicare member appeals. Each one starts from a different event, so the table below pairs each Healthfirst timely filing limit and appeal window with its trigger.

A timely filing limit, shortened to TFL in medical billing, is the window a payer gives you to get a claim in before it can deny for lateness alone. Under the Healthfirst timely filing limit for 2026, that window is 180 calendar days, weekends and holidays included.

If you've seen “Healthfirst TFL” on a denial worklist, the 180-day rule is what it refers to. Healthfirst posts policy changes on its Healthfirst for Providers claims page, so check there before you rely on any deadline, including the ones in this guide.

Healthfirst NY, Health First Health Plans, and Health First Colorado Are Different Payers

Three unrelated payers go by versions of the same name. Healthfirst, written as one word, is the not-for-profit plan in New York. Health First Health Plans is a Florida insurer whose commercial arm now does business as AdventHealth Advantage Plans. Colorado's Medicaid program goes by Health First Colorado.

A Health First timely filing limit of one year or six months comes from Florida's guidelines, and Healthfirst NY doesn't use them. The Health First claims address in Eagan, Minnesota belongs to the Florida plan as well. Mailing a New York claim there costs you days you can't get back.

The Healthfirst NY timely filing limit is the 180-day rule this guide covers. Before you trust any deadline you find online, check that the payer ID printed beside it reads 80141.

Why You See 60, 90, 120, and 365 Days for Healthfirst Online

Search for the Healthfirst timely filing limit and you'll see 60, 90, 120, or 365 days listed somewhere. Each number comes from a real rule. None of those rules sets the 180-day filing limit in Healthfirst's provider agreement, and mixing them up is how claims age out.

60 days is Healthfirst's second-level dispute deadline

Sixty days is Healthfirst's deadline for a second-level provider dispute, counted from the date on the reconsideration letter. Some AI search answers have listed it as Healthfirst's filing limit, which points billers at the wrong deadline. Use 60 days for disputes and nothing else.

90 days is the New York Medicaid fee-for-service rule

Ninety days is the initial filing limit for New York Medicaid fee-for-service claims billed through eMedNY, under 18 NYCRR 540.6. The eMedNY Guide to Timely Billing also lists 30-day windows for delays outside your control and a two-year outer limit. Those rules cover claims the state pays.

The Healthfirst Medicaid timely filing limit stays at 180 days, even though the state's own Medicaid timely filing limit for fee-for-service claims is 90. Other New York plans pick their own windows too, which is why the Fidelis timely filing limit needs its own lookup.

120 days comes from New York's prompt pay law

New York Insurance Law Section 3224-a(g) sets 120 days from the date of service as the default filing window for HMO and insurer claims, unless the contract gives the provider more time. The same rule lets providers agree to 90 days for Medicaid managed care and Child Health Plus.

Healthfirst's 180 days beats both figures. You'd cite NY Insurance Law Section 3224-a in a contract dispute. For day-to-day Healthfirst billing, the 180 days written into your agreement is the number to count against.

No Healthfirst document supports a one-year limit

One year shows up in two places that sound related. New York's late-claim reconsideration rule stops applying once you submit a claim 365 or more days after the date of service, and Original Medicare gives providers 12 months to file. Neither rule sets Healthfirst's deadline for participating providers.

A directory that lists one year for Healthfirst is wrong for contracted billing. If your team has been working from that number, pull your Healthfirst aging report today and check every unpaid claim older than 150 days.

Healthfirst Timely Filing Limit by Plan Type

Healthfirst sells Medicaid, commercial, Medicare Advantage, and long-term care plans in New York. For participating providers, the Healthfirst claims timely filing limit stays at 180 days across those lines. Enrollment requirements, claim format, and the state rules sitting under Healthfirst's contract are what change from plan to plan.

Healthfirst Medicaid timely filing limit: Medicaid managed care, HARP, and Child Health Plus

Medicaid managed care, HARP, and Child Health Plus claims get 180 days from the date of service at Healthfirst. That's twice the 90 days eMedNY allows for fee-for-service Medicaid, so don't let an eMedNY habit cut your Healthfirst window in half.

Check enrollment before you worry about the deadline. Federal managed care rules (42 CFR 438.602(b)) require network providers to enroll with the state, so you'll need active New York Medicaid enrollment under the NPI you bill with. Healthfirst will deny claims under an inactive enrollment no matter when you send them.

If Healthfirst shows your MCO status as inactive, hand it to whoever runs provider enrollment and credentialing. Your billers can't fix an enrollment record, and resubmitting the same claim won't help until that record changes. Each week spent resubmitting comes out of your 180 days.

Essential Plan, Leaf, and EPO plans

Healthfirst's Essential Plan, Leaf plans, and Pro and Total EPO plans use the same 180 days. New York's prompt pay law sets a 120-day baseline for insurer and HMO claims, and Healthfirst's contract gives you two extra months on top of it. Don't assume a commercial-style plan means a shorter Healthfirst insurance timely filing limit.

Healthfirst Medicare timely filing limit: Medicare Advantage and D-SNP plans

Healthfirst's Medicare Advantage lineup includes the Connection Plan and Life Improvement Plan, both HMO D-SNPs for members who have Medicare and Medicaid. Participating providers bill these claims under the same 180-day rule found in Healthfirst's provider agreement and Quick Reference Guide.

Don't borrow the 12-month window from Original Medicare. The Medicare timely filing rules govern claims you send to a Medicare Administrative Contractor, and a Healthfirst Medicare Advantage claim goes to Healthfirst under your Healthfirst contract. Out-of-network providers work under different terms, so confirm those with Provider Services before counting on any number.

Senior Health Partners MLTC and nursing home claims

CompleteCare Senior Health Partners, Healthfirst's managed long-term care plan, follows the 180-day rule too. The NYS nursing home billing guide, written for New York's move of nursing homes into Medicaid managed care, listed Healthfirst at 180 days from the date of service, with institutional claims on bill type 21X.

Facility billers should confirm that the current Senior Health Partners contract still says the same thing. A nursing home claim often covers a full month of care, so a single late claim can cost the facility thousands.

A practice billing four Healthfirst plan lines is watching several enrollment records and appeal clocks at once. If that's your team, MedSole RCM can track each one inside our outsourced medical billing services at 2.99% of collections, with no setup fees.

When the Healthfirst Filing Clock Starts and Stops

The Healthfirst timely filing limit starts counting on the date of service, and you've met it once Healthfirst receives the claim inside 180 days. Rejections, resubmissions, and corrections all happen inside that window. Your software's send date won't tell you where a claim stands, so track the status of each attempt.

Rejected claims and corrected claims run on different tracks

A rejected claim never reached adjudication. The clearinghouse or Healthfirst's front-end edits returned it for a problem like a bad member ID or a missing NPI, so Healthfirst has nothing on file to pay or deny. Fix it and send it again as a new claim within the same 180 days.

Keep the rejection report. Healthfirst accepts the RO59 Insurance Carrier Rejection Report as proof of timely filing, so if your fixed claim lands after day 180, that report shows your first attempt was on time.

Healthfirst corrected claims follow a different path. They replace a claim Healthfirst already accepted, and Section 17.6 of the Healthfirst NY Provider Manual points them back to the same 180-day rule in Section 17.3.

A clean 999 doesn't prove Healthfirst accepted your claim

A 999 acknowledgment confirms your file passed format checks. Healthfirst's answer on each claim inside that file comes back on the 277CA, which lists accepted and rejected claims one by one. For timely filing purposes, you need that claim-level answer.

Take a common scenario. A biller sends 40 Healthfirst claims, sees a clean 999, and moves on. Three of those claims rejected on the 277CA for invalid member IDs, and nobody opened that report for six weeks. Those three claims burned 42 days of their 180 for nothing.

Unread rejection reports are one of the quieter ways practices blow timely filing deadlines. Our accounts receivable follow-up team works rejections the day they post, so the proof stays in the claim file instead of sitting in an unread inbox.

Healthfirst Corrected Claim Timely Filing Limit

Healthfirst gives corrected claims 180 days from the date of service, the same window as a new claim. Corrections don't get a fresh clock. If you spot an error on day 175, Healthfirst's corrected claim TFL leaves you five days to get the replacement in.

Corrected claim, new claim, or reconsideration: pick the right route

Sending the wrong request type costs days you don't have, and a wrong route tends to mean a second denial before anyone notices. Match the problem to the request:

• Corrected claim: Healthfirst accepted the claim, but your data was wrong, such as a code, unit count, modifier, or date.
• New claim: the claim rejected and never loaded into Healthfirst's system, so you fix it and resend it.
• Reconsideration: your data was right, and you disagree with how Healthfirst paid or denied it.

How to submit a Healthfirst corrected claim on the 837 or on paper

1. Pull the original 13-character Healthfirst claim ID from the EOP or 835. It combines a two-digit branch code, a six-digit batch date, a three-digit batch sequence, and a two-digit sequence ID.
2. Set the claim frequency code to 7, which means replacement, in CLM05-3.
3. Enter the original claim ID in the REF*F8 segment of loop 2300.
4. Send the full claim with all of its lines, since a replacement claim replaces the whole original.
5. Mark paper claims “Corrected” and include the original Healthfirst claim number. Standard form rules add resubmission code 7 in Box 22 of the CMS-1500, or a type of bill ending in 7 on the UB-04.

Why Healthfirst corrected claims come back as duplicates

A missing or mistyped original claim ID is the first thing to check. Without REF*F8, Healthfirst reads your correction as a second claim for the same service and denies it as a duplicate. New York podiatrists reported that exact pattern with Healthfirst in 2022.

You lose days of the timely filing for a corrected claim with each duplicate denial, because the 180 days keep running while you sort it out. Pull the claim ID from the 835 instead of from memory, send one correction per claim, and confirm the 277CA shows it accepted.

Our claims submission services team checks the frequency code and REF*F8 fields before a correction goes out, which is cheaper than finding the problem on a remittance three weeks later.

Healthfirst Appeal Timely Filing Limit: Reconsideration and Disputes

Healthfirst's appeal deadlines sit outside its 180-day filing limit. You have 90 calendar days to request a review and reconsideration, then 60 calendar days to file a second-level dispute if you still disagree. Each clock starts from a Healthfirst document, so date-stamp those documents the day they arrive.

Level 1: Review and reconsideration within 90 days of the EOP paid date

Count from the paid date printed on the EOP. The day the EOP reaches your desk doesn't move the deadline. Healthfirst takes written reconsideration requests through its provider portal on Availity Essentials or by mail to the Healthfirst Correspondence Department, PO Box 958438, Lake Mary, FL 32795-8438.

Send a complete packet the first time. Healthfirst decides on what you send, and a thin packet that gets upheld leaves you arguing the same claim at level two with 60 days on the clock. Your packet should include:

• A copy of the EOP and the claim
• A written statement explaining what you disagree with and why
• The Healthfirst claim number, member ID, and date of service
• Supporting documents, such as the contract rate, eligibility proof, or proof of timely filing
• A contact name and phone number for follow-up

You'll get a decision within 30 calendar days. Healthfirst dismisses any request that arrives after day 90 without reviewing the merits, so file early enough to fill a gap if Healthfirst asks for more information.

Level 2: Formal dispute within 60 days of the reconsideration letter

If reconsideration goes against you, you get one more level. File a written dispute within 60 calendar days of the date on the reconsideration letter and mail it to Healthfirst Provider Claim Appeals, PO Box 958431, Lake Mary, FL 32795-8431.

Include a copy of the reconsideration decision, a clear statement of why it's wrong, and the Healthfirst tracking number if you filed level one through the portal. Healthfirst rejects appeals that aren't in writing or that leave out the reason. Building packets like this is everyday work for our denial management services team.

Member appeals and pre-payment review run on their own clocks

Healthfirst Medicare members get 65 days from a coverage decision notice to file their own appeal. That right belongs to the member or a representative, and it's separate from your provider dispute rights. The Healthfirst Medicare appeals page explains the member process.

Pre-payment review has its own schedule. If Healthfirst places you on PPR, you have 45 calendar days to send requested records, 90 days to ask for PPR reconsideration, and 60 days for a further appeal.

What Happens If You File a Healthfirst Claim Past the Limit

Healthfirst denies it. A first-time claim that reaches Healthfirst after day 180 falls outside the Healthfirst timely filing limit, and the remittance shows claim adjustment reason code 29, meaning the time limit for filing has expired. You'll often see it written as CO-29.

Don't move that balance to the patient. Healthfirst's provider manual includes a member hold harmless section (Section 16.8), and Medicaid payment-in-full rules bar you from balance billing members for covered services. In most cases, a timely filing denial on a covered service ends as a practice write-off.

Check whether the claim was late at all

Start with the claim history. If an earlier submission exists, an RO59 rejection report or an Emdeon claim summary can show you filed on time. Request reconsideration within 90 days of the EOP paid date and attach that proof.

Don't assume eMedNY's delay reason codes carry over. Litigation, retroactive eligibility, and similar 30-day windows come from fee-for-service Medicaid rules. For a Healthfirst claim, look to Section 17.3 of the Healthfirst manual and your contract for any exception.

New York's unusual-occurrence rule for late claims

New York gives participating providers one more option. Under Insurance Law Section 3224-a(h), you can ask a plan to reconsider a claim denied solely for late filing if you show an unusual occurrence caused the delay and you have a pattern of filing on time. Healthfirst can then pay, but it may cut payment by up to 25%.

The rule doesn't cover claims you submit 365 or more days after the date of service. New providers get a second protection: under New York's provisional credentialing rule, a plan can't deny a provisionally credentialed professional's claim on appeal for lateness alone. The NY DFS provider rights page explains both rules.

If CO-29 denials keep showing up on your Healthfirst remits, the cause sits upstream: claims go out late, or rejections sit unworked. Our CO-29 denial recovery work starts by finding which one it is, then fixing the workflow that let it happen.

Proof of Timely Filing Healthfirst Accepts

Healthfirst names two reports as proof of timely filing: the RO59 Insurance Carrier Rejection Report and the Emdeon Vision “Claim for Review” or “Claim Summary” report. Emdeon renamed itself Change Healthcare in 2015, so longtime billers may know these reports under either name.

File evidence by claim number, not by batch. A 277CA or an Availity submission confirmation shows that a specific claim reached Healthfirst, while a 999 proves the file arrived and nothing more. If your clearinghouse can't produce an RO59, ask Provider Services which current report Healthfirst accepts before you need it for an appeal.

Switching clearinghouses is a bigger project, but if yours can't pull claim-level reports on demand, our clearinghouse comparison guide lays out the major vendors and what each one costs.

Healthfirst Payer ID, Claims Address, and Provider Contacts

The Healthfirst payer ID is 80141. Electronic claims need three identifiers to route: your NPI, the member's Healthfirst ID number, and payer ID 80141. The Healthfirst claims address for paper claims and the contacts below come from Healthfirst's Quick Reference Guide and its provider website.

Contacts verified October 2, 2026.

Healthfirst directs claim questions to Provider Services, so 1-888-801-1660 works as the Healthfirst provider phone number for claims, eligibility, and status checks. If someone on your team asks for the Healthfirst insurance claims department, that's the line to call.

Several third-party websites copy the Healthfirst portal name and layout. Log in through the link on hfproviders.org so your member data goes to Healthfirst and stays away from lookalike sites.

How to Keep Healthfirst Claims Inside the 180-Day Window

The Healthfirst timely filing limit gives you about six months, which sounds generous. Claims that miss it tend to stall early, in an unread rejection report or an eligibility error nobody caught, and sit there until the window closes. Internal deadlines set ahead of Healthfirst's give you room to recover.

Five habits keep Healthfirst claims moving long before any of those targets come close, and none of them needs new software:

• Check 277CA acceptance reports each business day
• Keep rejections and denials in separate work queues
• Verify eligibility, plan line, and provider participation before the visit
• Track each deadline from its own trigger date
• File proof of timely filing under the claim number

Healthfirst timely filing problems tend to start at the front desk, where a wrong member ID or plan line slips through. Our team runs deadline-driven AR follow-up to catch those claims and work them before day 30.

Healthfirst keeps adjusting its review rules, too. It started Cotiviti claim pattern reviews on August 1, 2026, and new prior authorization requirements took effect October 1, 2026, so check the provider alerts on hfproviders.org each month.

If your team can't watch these clocks every day, we can. Our medical billing at 2.99% covers Healthfirst claim submission, rejection work, and appeals, with no setup fees or long-term contracts.

How MedSole RCM Handles Healthfirst Claims and Credentialing

MedSole RCM is a US medical billing and revenue cycle management company that charges 2.99% of collections for full-service billing and $99 per insurance for credentialing, with no setup fees. We publish both prices, so you can compare them before you call anyone.

That 2.99% covers eligibility checks, claim submission, payment posting, denial management and appeals, AR follow-up, and monthly reporting. A typical percentage-based billing quote runs 4% to 7% of collections for similar work. You won't pay separate software fees, and you won't sign a long-term contract.

On Healthfirst claims, our billers track each claim against its plan line and trigger date, confirm acceptance on the 277CA instead of trusting the 999, and send corrections with the original claim ID in REF*F8. We file reconsiderations by day 60, which keeps your claims inside the Healthfirst timely filing limit and its appeal clocks.

Credentialing comes first, though. Healthfirst pays participating providers, and New York gives plans 60 days to decide on a complete credentialing application. A newly licensed or relocating New York professional joining a participating group counts as a participating provider from day 61 until the plan decides.

Our credentialing at $99 per insurance covers the Healthfirst application and follow-up. For the other New York plans you may need, such as Fidelis Care, MetroPlus, and EmblemHealth, our NY Medicaid MCO credentialing team runs those applications in parallel.

Send us a recent Healthfirst aging report, and we'll show you which balances are still recoverable and which deadlines are closest. Start with a free billing analysis.

Healthfirst Timely Filing FAQs

What is the Healthfirst timely filing limit?

The Healthfirst timely filing limit is 180 calendar days from the date of service for participating providers. It covers initial and corrected claims across Healthfirst's Medicaid, commercial, and Medicare Advantage plans. After a claim processes, you have 90 days from the EOP paid date to request reconsideration and 60 days from the reconsideration letter to file a second-level dispute.

How long does it take to file a Healthfirst claim?

You have up to 180 days from the date of service, but filing within 30 days leaves time to catch rejections and fix them. Once Healthfirst receives a clean claim, New York's prompt pay rules require payment within 30 days for electronic claims and 45 days for paper or fax claims.

What is a timely filing limit in medical billing?

A timely filing limit is the deadline a payer sets for receiving a claim, counted from the date of service in most cases. Miss it, and the payer can deny the claim for lateness alone, even when the care was covered and coded right. eMedNY allows 90 days for fee-for-service Medicaid, Healthfirst allows 180, and Original Medicare allows 12 months.

What happens if I file a Healthfirst claim past the limit?

Healthfirst denies the claim with reason code 29 (CO-29). If an RO59 or Emdeon report proves an earlier on-time submission, request reconsideration within 90 days of the EOP paid date. Participating providers can also cite New York's unusual-occurrence rule, under which Healthfirst may pay the claim with up to a 25% reduction. In most cases, you can't bill the patient.

What is the Healthfirst corrected claim timely filing limit?

Healthfirst corrected claims follow the same 180 days from the date of service as new claims. Mark the claim corrected, set frequency code 7, and put the original 13-character Healthfirst claim ID in REF*F8 of loop 2300. A correction sent without that ID tends to come back as a duplicate denial while the 180-day clock keeps running.

What is the Healthfirst appeal timely filing limit?

Healthfirst uses two appeal deadlines, and neither one extends the 180-day filing limit. Request review and reconsideration within 90 calendar days of the paid date on the EOP. If you disagree with the result, file a written dispute within 60 calendar days of the reconsideration letter with Healthfirst Provider Claim Appeals, PO Box 958431, Lake Mary, FL 32795-8431.

What is the Healthfirst Medicare timely filing limit?

Participating providers have 180 days from the date of service to file Healthfirst Medicare Advantage claims, including Connection Plan and Life Improvement Plan claims. Original Medicare's 12-month window doesn't apply to those claims. Out-of-network providers should confirm their terms with Healthfirst Provider Services at 1-888-801-1660 before relying on any deadline.

Is the Health First timely filing limit the same in Florida?

No. Health First Health Plans in Florida is a separate company with payer ID 95019; its guidelines allow one year for Medicare Advantage and six months for commercial claims. Healthfirst in New York uses payer ID 80141 and a 180-day limit. Health First Colorado, the state's Medicaid program, allows 365 days.

What does it cost to outsource Healthfirst billing and credentialing?

MedSole RCM is a US medical billing and revenue cycle management company that charges 2.99% of collections for full-service billing and $99 per insurance for credentialing, with no setup fees. For a Healthfirst practice, that means full-service medical billing covering claim submission, rejections, appeals, and AR follow-up at 2.99%, plus $99 for the Healthfirst credentialing application. There's no long-term contract.

What should a New York practice look for in a billing company for Healthfirst claims?

Look for a team that tracks Healthfirst deadlines by plan line and trigger date, confirms 277CA acceptance daily, and files written reconsiderations and disputes on time. Ask whether credentialing is included and pricing is published. MedSole RCM bills at 2.99% of collections, credentials at $99 per insurance, and enrolls providers with Healthfirst, Fidelis Care, and MetroPlus.

Sources and How We Verified This Guide

We verified this Healthfirst timely filing limit guide on October 2, 2026, against the sources below. Payer deadlines change, so we recheck them whenever Healthfirst publishes a new provider manual edition.

• Healthfirst NY Provider Manual, Sections 16 and 17
• Healthfirst provider Quick Reference Guide (claims, appeals, and contacts)
• Healthfirst for Providers claims page
• NY Insurance Law Section 3224-a
• NY DFS prompt pay guidance
• eMedNY Guide to Timely Billing
• NYS nursing home billing guide

If your Healthfirst agreement shows a different deadline, email us at info@medsolercm.com, and we'll check it against the source and update this page.