MetroPlus Timely Filing Limit 2026: Claim, Appeal, Corrected, and Secondary Claim Deadlines

Quick answer: The MetroPlus timely filing limit is 90 days from the date of service or discharge, according to MetroPlusHealth's Claims page. MetroPlus's own notices also list 120 days for participating providers and 180 days for non-participating providers. Your participation agreement controls, so file inside 90 days unless your contract gives you more time in writing.

MetroPlus deadlines at a glance

• Initial claim (Claims page): 90 days from the date of service or discharge
• Participating and non-participating providers (2023 notice, 2026 tip sheet): 120 days and 180 days
• Records MetroPlus requests: 30 days from the request date
• MetroPlus as secondary payer: 60 days from receipt of the primary EOB
• Payment appeals, NY State products: 45 calendar days from the check or denial notice
• Payment reconsiderations, Medicare and MAP: 65 calendar days from the remittance date
• Late claims, NY State products: reconsideration possible, with payment cut by up to 25%

What Is the MetroPlus Timely Filing Limit in 2026?

MetroPlusHealth's Claims page sets the MetroPlus timely filing limit at 90 days from the date of service or discharge. A July 2023 provider notice and a 2026 nursing home tip sheet use 120 days for participating providers and 180 days for non-participating providers. Your contract decides which number binds you.

What Each MetroPlus Source Says

Search the MetroPlus Health Plan timely filing limit and you'll find three different numbers. MetroPlus published all of them. Billers who check a single page tend to grab the first number they see, and that's how a practice ends up working to 180 days on a 90-day contract.

MetroPlus timely filing rules as published (checked October 4, 2026)

None of these pages explains the gap between 90 and 120 days. New York's prompt pay law does, and it also tells you which number is safe to plan around.

Which Deadline Controls Your Claim?

Your participation agreement wins. MetroPlus's 2023 notice says its timely filing provision applies "unless the participation agreement states an alternative time frame." Pull your contract, find the claims submission clause, and write that number on your payer grid.

Receipt date counts as well. The notice talks about claims "received" after the deadline, so MetroPlus measures from the day it gets the claim. A claim you send on day 89 can still land late if it sits in a clearinghouse queue or a mailroom over a long weekend.

Treat 90 days as your working MetroPlus timely filing limit. It's the shortest number MetroPlus publishes, so it keeps you safe on every line of business even when your contract allows 120. Use any extra days your contract gives you as a cushion for corrections.

The 180-day window helps only if you're non-participating. If your MetroPlus provider enrollment is still in process, confirm your participation effective date before you bill, because MetroPlus can handle claims dated before it as out-of-network. When your provider enrollment and credentialing wraps up, enter that effective date in your billing system so nobody bills ahead of it.

If the contract language is unclear, call MetroPlus Provider Services at 1-800-303-9626 and ask which timely filing period applies to your agreement. Write down the representative's name, the date, and the call reference number. You'll want that record if a denial ever turns on it.

Why MetroPlus Lists 90 Days in One Place and 120 in Another

MetroPlus is a New York HMO, and New York's prompt pay law gives HMO claims two numbers: a 120-day default and a 90-day floor for government program contracts. Read side by side, MetroPlus's published deadlines line up with both.

The 120-day default comes from New York Insurance Law § 3224-a. Subsection (g) says claims "must be initially submitted by health care providers within one hundred twenty days after the date of service." The rule covers insurers and HMOs licensed or certified in New York.

The same subsection lets plans and providers agree on terms "more favorable to the health care provider." For Medicaid managed care, Family Health Plus, and Child Health Plus contracts, the parties can pick a different period, "but in no event less than ninety days." New York sets that as the floor.

Put those rules next to MetroPlus's pages and the numbers make sense. The 90 days on the Claims page sits at the government program floor. MetroPlus's 120 days for participating providers matches the state default. The 180 days for non-participating providers is MetroPlus's own rule, and the most generous of the three.

MetroPlus doesn't explain the gap anywhere on its site, so treat this as our reading of how the numbers fit. The state law also stops short of Medicare Advantage. MetroPlus's Medicare plans follow federal rules and the terms of your Medicare contract.

Every New York HMO works under the same statute. That's why the MetroPlus timely filing limit looks so much like the Fidelis timely filing limit for New York Medicaid business, which also sits at 90 days.

Quick reference

• 120 days: New York's default for HMO claims
• 90 days: the shortest period a Medicaid managed care, Family Health Plus, or Child Health Plus contract can set

MetroPlus Timely Filing Limits by Line of Business

Your MetroPlus timely filing limit stays close to 90 days on every plan. The rules behind that number change from plan to plan, and so does the appeal window. Match each plan to its published deadline before you build payer rules into your billing system.

MetroPlus timely filing schedule by plan (as published; your contract controls)

MetroPlus Medicaid Timely Filing Limit: Medicaid, HARP, Essential Plan, and CHP

MetroPlusHealth is the health plan of NYC Health + Hospitals, and it runs a Medicaid managed care plan for New York City residents. Claims for MetroPlus Health Medicaid members follow your MetroPlus contract instead of eMedNY's fee-for-service rules. New York law keeps that contract deadline at 90 days or longer.

HARP, Essential Plan, and Child Health Plus claims work the same way. One prerequisite trips up new providers: you need an active New York Medicaid enrollment before a Medicaid managed care plan can credential you. Our guide to New York Medicaid provider enrollment walks through that first step.

MetroPlus Medicare Advantage and D-SNP Plans

MetroPlus isn't Medicare. Its Medicare products are HMO and HMO D-SNP plans that contract with Medicare, and MetroPlus pays those claims under its own rules. A biller who applies Medicare's 12-month rule to these plans can miss MetroPlus's 90-day window by nine months.

Use your MetroPlus contract and the 90-day Claims page guidance for Platinum, Advantage, and UltraCare members. Appeal rights differ on these plans as well, with a 65-day window and an extra form for in-network providers.

Nursing Home and Behavioral Health Claims

MetroPlus's 2026 Nursing Home Transition Tip Sheet gives participating providers 120 days and non-participating providers 180 days "to avoid late filing denials." The same sheet sets a window of 60 calendar days for claims reconsiderations, counted from the date of the remittance advice.

Behavioral health claims fall under the 90-day rule on MetroPlus's Behavioral Health Claims page. The page says the rule applies whether your practice is paid capitated or fee-for-service, so a capitated group still has to submit encounter detail on time.

Eight plan types, three published limits, and two appeal clocks add up to a lot of dates to track by hand. If MetroPlus claims keep aging past day 90 in your AR, our outsourced medical billing team works them at 2.99% of monthly collections and prioritizes every claim by its filing deadline.

Secondary Claims, Requested Records, and Corrected Claims

Three more deadlines run alongside the MetroPlus timely filing limit. Each one starts its clock on a different date, and a practice that tracks only the date of service will miss all three sooner or later.

When MetroPlus Is Secondary: 60 Days From the Primary EOB

MetroPlus's 2023 notice says the primary payer's explanation of benefits "should be submitted within 60 days of receipt" when MetroPlus pays second. Your clock starts when you receive the primary EOB, so a claim with a January date of service can still be on time in May.

Say a patient's employer plan is primary and MetroPlus Medicaid is secondary. The primary EOB arrives March 3. You have until May 2 to get the secondary claim, with that EOB attached, to MetroPlus.

Start the secondary claim the day the primary payment posts. Coordination of benefits delays often begin earlier, at check-in, when nobody asks the patient about other coverage. Your front desk can catch the second plan before the visit with solid benefit verification, so the secondary claim is ready when the EOB lands.

When MetroPlus Requests More Information: 30 Days

MetroPlus gives you 30 days "from the requested date" to send records it asks for. The clock runs from the date printed on the request, even if the letter sits unopened in the mailroom for a week.

Portal messages nobody reads are a common way to lose this window. Pick one person to check MetroPlus correspondence every day, and log each request next to the claim with its 30-day due date.

MetroPlus Corrected Claims Timely Filing Limit

As of October 4, 2026, MetroPlus's public claims pages don't publish a separate MetroPlus corrected claim time frame. The Claims page, the Reimbursement Policies page, and the Claims FAQs all stay silent on it, so plan as if the original filing window still applies.

Get the corrected claim accepted inside the original window whenever you can. On a CMS-1500, enter frequency code 7 (replace) or 8 (void) in box 22 with the original MetroPlus claim number. A UB-04 carries the 7 or 8 in the last digit of the type of bill and the original claim number in field 64.

A rejected claim doesn't stop the clock. If a clearinghouse rejects a claim, MetroPlus never received it, so nothing counts as filed until a clean version gets through. Confirm the corrected claim window in your contract or with Provider Services when a correction is running close.

For comparison, New York Medicaid fee-for-service gives providers 60 days from notification to correct and resubmit a claim, according to the eMedNY Guide to Timely Billing. That rule belongs to eMedNY, so use it as a benchmark for MetroPlus claims and nothing more.

How to Calculate Your MetroPlus Filing Deadline

To find your MetroPlus timely filing limit date, count calendar days forward from the date of service. For inpatient stays, count from the discharge date. MetroPlus measures to the day it receives the claim, so the day you hit submit doesn't settle the question.

Example deadlines for a January 15, 2026 date of service

MetroPlus doesn't publish a rule that pushes a weekend or holiday deadline to the next business day. Assume you won't get the extra day. April 15, 2026, falls on a Wednesday, but plenty of deadlines land on a Saturday.

Your real MetroPlus health claim filing time should sit well inside the limit. Build internal targets like these into your workflow:

1. Submit every MetroPlus claim within seven days of the visit.
2. Flag any unpaid claim at day 45 for AR follow-up.
3. Treat day 60 as the last safe day to fix and resend a rejected claim.

MetroPlus has extended deadlines before. During the 2024 Change Healthcare outage, MetroPlus added 30 days to timely filing for affected claims, then reinstated standard timeframes on July 1, 2024. The MetroPlus Change Healthcare update page records that history, and MetroPlus lists no similar extension as of October 4, 2026.

MetroPlus Appeal Timely Filing Limits by Plan

MetroPlus appeal timely filing depends on the plan. New York State products get 45 calendar days, and Medicare plans and MAP get 65 calendar days, according to the MetroPlus Medicare appeals page updated September 30, 2026. Older MetroPlus documents still say 60 days for Medicare, so check the date on whatever you're reading.

MetroPlus payment appeal deadlines (checked October 4, 2026)

NY State Products: 45 Calendar Days

Payment reconsiderations for New York State products must reach MetroPlus within 45 calendar days of the initial check or the denial notice. Send a written statement explaining why you disagree, a copy of the original claim, a copy of the Explanation of Payment, and the documents that support your position.

MetroPlus lists payment appeals at MPH Customer Service Appeals, 50 Water Street, 7th Floor, New York, NY 10004, phone 1-866-986-0356, fax 1-212-908-3011. The Claims page shows a different appeal fax, 1-212-908-8789, so confirm the right fax with Provider Services before you send anything time-sensitive.

Medicare and MAP: 65 Days, AOR, and WOL

Out-of-network providers, members, and authorized representatives have 65 calendar days from the remittance notification date to request a payment reconsideration on Medicare and MAP claims. An out-of-network provider must also attach a Waiver of Liability statement, which confirms you won't bill the member for the disputed amount.

In-network providers can't appeal Medicare claims in their own name. You file on the member's behalf with a signed CMS-1696 Appointment of Representative form. MetroPlus's Reimbursement Policies page gives in-network providers 60 calendar days from the EOP paid date, while the appeals page says 65. File within 60 and you're covered under both.

MAP members can also appeal by phone. Older MetroPlus reconsideration PDFs still show 60 days for out-of-network providers, so check the date on any document before you rely on it.

What Happens After You File

MetroPlus issues a written decision within 60 calendar days of receiving a payment reconsideration. If MetroPlus upholds a denial on a Medicare or MAP claim, it sends the case to the Independent Review Entity without waiting for you to ask.

Corrected payments can arrive as adjustments added to or subtracted from future remittances. Match each adjustment back to the original claim, and keep a dated unpaid claim follow-up log so the 60-day decision window doesn't slip by.

Missed the Deadline? New York's Late Claim Reconsideration Rule

Missing the MetroPlus timely filing limit doesn't always end the claim. For New York State products, MetroPlus says providers "may request reconsideration of rejected claims submitted after the filing deadline," and payment "may be reduced up to 25%."

MetroPlus may pay a claim it denied as late if you show two things: the delay came from unusual circumstances, and your practice has a record of submitting claims on time. The appeals page lists this rule under NY State products only, so Medicare plan claims don't get the same second chance.

New York Insurance Law § 3224-a(h) requires plans to pay a participating provider's late claim when the provider shows an "unusual occurrence" and a "pattern or practice of timely submitting claims." The plan can cut payment by no more than 25%. The rule stops applying to claims submitted 365 days or more after the date of service.

Build the request around evidence. Attach proof of the unusual event, such as a clearinghouse outage notice or the date your practice switched systems. Add a report of your on-time filing rate for MetroPlus and proof the late claim was otherwise clean. The statute doesn't define "unusual occurrence," so argue your specific facts.

Can You Bill the Patient for a Timely Filing Denial?

No. MetroPlus prohibits balance billing, and its 2024 Provider Manual says that when a request isn't timely filed, providers "may not bill members for services rendered." Your practice absorbs a MetroPlus timely filing denial as a write-off, and the patient owes nothing extra for it.

If CO-29 denials are already sitting in your MetroPlus AR, the 365-day cutoff is the clock to watch now. Our timely filing denial management team works these reconsiderations as part of the 2.99% billing rate, or for 4.49% of what's recovered as a standalone service.

How to Prove Timely Filing After a CO-29 Denial

A CO-29 denial means the payer says "the time limit for filing has expired," the official description in the X12 claim adjustment reason codes list. To overturn it with MetroPlus, you need proof that MetroPlus received the claim inside the window. Proof that you sent it carries less weight.

Gather proof in this order, strongest first:

1. The 277CA claim acknowledgment showing the payer accepted the claim, with its date
2. The 999 acknowledgment showing your clearinghouse accepted the file
3. A MetroPlus claim number or a dated claim status screen from the MetroPlus provider portal
4. A certified mail receipt with the delivery date, plus a copy of the paper claim
5. The MetroPlus request letter and proof of your response date, for records requests

MetroPlus asks for this evidence by name. Its Provider Manual lists "evidence of timely filing" among the items a reconsideration request should include, next to the claim number and the member's details.

MetroPlus has accepted electronic claims through Availity since March 11, 2024, under payer ID 13265. A 999 proves only that the clearinghouse took the file, so keep the matching 277CA too. With a clean claim submission workflow, your team saves both reports for every MetroPlus batch and can answer a CO-29 the same day.

If your current setup can't pull a 277CA on demand, compare your options in our review of medical billing clearinghouses. Keep acknowledgment reports at least as long as your longest appeal window.

MetroPlus Claim Submission Details: Payer ID, Addresses, and Phone Numbers

The MetroPlus provider phone number for claims is 1-800-303-9626, the Provider Services line on the Claims page. Use the table below as a submission reference. We checked every line against MetroPlus's own pages on October 4, 2026.

MetroPlus claim submission reference (checked October 4, 2026)

MetroPlus Claims Mailing Address

MetroPlus's Claims page, updated September 10, 2026, lists one paper claims address for every plan, Medicare included: MetroPlus Health Plan, PO Box 830480, Birmingham, AL 35283-0480. The older MetroPlus Claims FAQs page, last updated May 22, 2024, still shows Kansas City, Missouri PO boxes.

Go with the newer Claims page, and call Provider Services before you mail anything close to a deadline. Send paper claims by certified mail so you have a delivery date on record if MetroPlus ever disputes receipt.

How MetroPlus Compares to Other New York Payers

The MetroPlus timely filing limit sits with the shorter deadlines in New York. Several large New York Medicaid plans use 90 days, so a practice billing more than one of them can run a single 90-day rule across its Medicaid work.

Initial filing limits for common New York payers

Anthem has the widest gap between participating and non-participating providers in this group. You'll find its plan-by-plan rules in our guide to Anthem Blue Cross deadlines.

Keeping MetroPlus Claims Inside the Window

Staying under the MetroPlus timely filing limit starts at check-in, long before anyone builds a claim. Late MetroPlus claims tend to trace back to the same few process gaps, and your team can close each one with a change to daily routine:

1. Verify eligibility and other coverage at check-in, so secondary claims start on time.
2. Get the MetroPlus prior authorization form approved before the visit, since an authorization denial means a resubmission inside the same filing window.
3. Submit every MetroPlus claim within seven days of the visit.
4. Check for the 999 and 277CA acknowledgments within 48 hours of each batch.
5. Track the 30-day records clock and the 60-day secondary clock on a dated worklist.
6. Recheck MetroPlus's claims pages and your participation agreement every quarter.

For each new provider, confirm the MetroPlus provider enrollment effective date before the first claim goes out. Claims billed ahead of that date can sit in limbo until enrollment catches up, and the filing clock keeps running the whole time.

MedSole RCM is a full-service revenue cycle management company. Medical billing is 2.99% of monthly collections, and provider enrollment and credentialing is $99 per payer application.

If you're comparing third party medical billing companies, ask whether credentialing is included and what it costs per payer. We run medical billing at 2.99% with every claim prioritized by its filing deadline. New providers get credentialing at $99 per payer, so effective dates are on file before they see MetroPlus patients.

Both services run under one team as part of our revenue cycle management work, inside the EHR you already use. If MetroPlus deadlines keep slipping in your AR, we're glad to look at where the claims are stalling and show you what we find.

MetroPlus Timely Filing FAQs

What is the MetroPlus timely filing limit for participating providers?

Participating providers have 120 days from the date of service or discharge under MetroPlus's 2023 timely filing notice and its 2026 Nursing Home Transition Tip Sheet. MetroPlus's Claims page lists 90 days, and your participation agreement controls when the two differ. Bill to 90 days unless your contract states a longer period in writing.

What is the MetroPlus Health Plan timely filing limit for non-participating providers?

Non-participating providers have 180 days from the date of service or discharge, according to MetroPlus's 2023 notice and the 2026 nursing home tip sheet. MetroPlus measures that window to the date it receives the claim. Out-of-network payment rules also apply, so check the member's out-of-network benefits before you see them as a non-participating provider.

What is the MetroPlus Health Plan appeal timely filing limit?

MetroPlus gives providers 45 calendar days to appeal payment decisions on New York State products, counted from the initial check or denial notice. Medicare and MAP claims get 65 calendar days from the remittance notification date for out-of-network providers, members, and representatives. In-network providers file for the member with a CMS-1696 form, and 60 days is the safe target.

What is the MetroPlus corrected claims timely filing limit?

MetroPlus doesn't publish a separate corrected claims deadline on its public claims pages as of October 4, 2026. Get the corrected claim accepted inside the original filing window, bill it with frequency code 7 or 8 and the original claim number, and confirm any longer window in your contract or with Provider Services.

What is the MetroPlus Health Plan provider phone number for claims?

Call MetroPlus Provider Services at 1-800-303-9626 for claim status and timely filing questions. For payment appeals, MetroPlus lists 1-866-986-0356 on its appeals page. Have the member ID, date of service, and claim number ready before you call, and use the provider portal for status checks on larger batches.

What is the MetroPlus claims mailing address?

MetroPlus's Claims page, updated September 10, 2026, lists MetroPlus Health Plan, PO Box 830480, Birmingham, AL 35283-0480 for paper claims on every plan, Medicare included. An older Claims FAQs page still shows Kansas City addresses, so confirm with Provider Services before you mail anything close to a deadline.

Is MetroPlusHealth NY Medicaid?

MetroPlusHealth isn't New York Medicaid itself. It's the health plan of NYC Health + Hospitals and runs a Medicaid managed care plan, along with HARP, Essential Plan, Child Health Plus, Marketplace, and Medicare HMO and HMO D-SNP plans. Claims for its Medicaid members follow your MetroPlus contract instead of eMedNY fee-for-service rules.

Is MetroPlus in New Jersey?

No. MetroPlusHealth's insurance FAQs say New Jersey residents aren't eligible for its plans, except for emergency services. MetroPlus serves New York City, with one exception for NYC employees on its commercial plans who live outside the service area but must use MetroPlus participating providers.

Which third party medical billing company can handle MetroPlus claims and credentialing?

MedSole RCM handles MetroPlus claims, denials, and AR follow-up for medical practices at 2.99% of monthly collections, and provider enrollment and credentialing at $99 per payer application. The team works inside your existing EHR, so your staff doesn't switch systems. Smaller groups can see how that pricing works out in our guide to billing for small practices.

Sources (checked October 4, 2026)

• MetroPlusHealth: Claims
• MetroPlusHealth: Important Update, Timely Claim Filing Requirements
• MetroPlusHealth: Reimbursement Policies
• MetroPlusHealth: Behavioral Health Claims
• MetroPlusHealth: Provider Quick Reference Guide
• MetroPlusHealth: 2026 Nursing Home Transition Tip Sheet (PRV 26.019)
• MetroPlusHealth: Medicare Grievance, Coverage Determination and Appeals
• MetroPlusHealth: 2024 Provider Manual
• MetroPlusHealth: Change Healthcare Update
• MetroPlusHealth: Claims FAQs
• MetroPlusHealth: Insurance FAQs
• New York State Senate: Insurance Law § 3224-a
• eMedNY: Guide to Timely Billing
• CMS: Form CMS-1696, Appointment of Representative
• X12: Claim Adjustment Reason Codes

MetroPlus updates its provider pages without notice. We recheck this guide every quarter and update the date at the top when anything changes.