Presbyterian Timely Filing Limit 2026: Every Claim, Correction, and Appeal Deadline, Cited to Presbyterian's Own Documents

The MedSole RCM claims team last checked these deadlines on October 4, 2026. Sources: Presbyterian's 2026 Universal Practitioner and Provider Manual (revision F) and 2026 Turquoise Care Practitioner and Provider Manual (revision C), both dated July 21, 2026.

The Presbyterian timely filing limit for in-network providers is three months from the date of service, or 90 days for Turquoise Care Medicaid. Presbyterian Health Plan in New Mexico must receive claims within those windows, under its 2026 manuals. Corrections and appeals get 12 months from the date of service.

Several payer lookup sites and quick-reference charts list 12 months as Presbyterian's filing limit. That's the window for corrections and appeals. A team that schedules first submissions against a 12-month clock can file up to nine months late, and Presbyterian denies those claims for timely filing.

This guide covers Presbyterian Health Plan, Inc. and Presbyterian Insurance Company, Inc. of Albuquerque, New Mexico. NewYork-Presbyterian, Texas Health Presbyterian, and PEHP are separate organizations with their own filing rules, so don't apply these deadlines to their claims.

Check the product on the member's ID card before you count days. Presbyterian's Universal manual sets the clock for commercial and Medicare Advantage plans, and the Turquoise Care manual sets it for Medicaid. The table below lists the Presbyterian claims timely filing limit by claim type.

Presbyterian timely filing limit by claim type (2026)

Presbyterian Health Plan Timely Filing Limit by Line of Business

The Presbyterian Health Plan timely filing limit depends on the product. Presbyterian's 2026 manuals give in-network commercial and Medicare Advantage claims three months from the date of service and Turquoise Care Medicaid claims 90 days. Member-submitted claims follow separate rules. Read the ID card first.

Commercial HMO, POS, and PPO Claims: Three Months

Presbyterian must receive in-network commercial HMO, POS, and PPO claims within three months of the date of service. That rule comes from the 2026 Universal Practitioner and Provider Manual. Presbyterian Health Plan, Inc. offers the HMO, POS, and ASO products, and Presbyterian Insurance Company, Inc. offers the group PPO.

The manual says receive, so Presbyterian counts the day your claim arrives. A paper claim you mail on day 88 can miss the deadline. Group PPO claims follow the same Presbyterian insurance timely filing limit, and inpatient facility claims start the three-month clock at discharge.

Medicare Advantage Claims (Senior Care, Dual Plus, and MediCare PPO): Three Months

For contracted providers, the Presbyterian Medicare Advantage timely filing limit is three months from the date of service. Presbyterian's 2026 Universal manual sets that rule and covers Presbyterian Senior Care (HMO and HMO-POS) and Presbyterian Dual Plus (HMO D-SNP). The network page on phs.org lists Presbyterian MediCare PPO with those Medicare Advantage plans.

Don't borrow Original Medicare's 12-month rule for these claims. That Medicare timely filing window applies to fee-for-service claims sent to a Medicare Administrative Contractor. Your Presbyterian contract and manual govern Medicare Advantage claims. Senior Care plans end December 31, 2026, so track which dates of service fall before the cutoff.

Turquoise Care (Medicaid) Claims: 90 Days

Presbyterian's 2026 Turquoise Care Practitioner and Provider Manual sets the Presbyterian Turquoise Care timely filing limit at 90 days from the date of service. Inpatient facility claims start the 90-day clock at discharge. New Mexico's Medicaid billing rule, 8.302.2.11 NMAC, sets the same 90 calendar days, so the Presbyterian Medicaid timely filing limit matches state law.

Older Presbyterian PDFs refer to Centennial Care and the Human Services Department (HSD). Turquoise Care replaced Centennial Care on July 1, 2024, and HSD became the Health Care Authority (HCA). You'll hit those older documents if you search for the Presbyterian Centennial Care timely filing rule, so work from the 2026 Turquoise Care manual.

Member-Submitted and Out-of-Network Claims: 90 Days or One Year

Presbyterian's claims payment policies give members 90 days from the date of service to send written proof of an in-network claim. Out-of-network claims get one year from the date of service. The member stays responsible for that one-year deadline when an out-of-network provider files the claim.

OPM's brochure for Presbyterian's Federal Employees Health Benefits (FEHB) plan sets December 31 of the year after the service year as the member's claim deadline. Those three deadlines apply to members. A contracted practice filing its own claims with Presbyterian uses the provider-side Presbyterian timely filing limit from the 2026 manuals.

When the Presbyterian Filing Clock Starts and Restarts

The Presbyterian claims timely filing limit runs three months, or 90 days for Turquoise Care, from the date of service on professional claims. On inpatient facility claims, the clock starts at discharge. Presbyterian Health Plan's 2026 manuals set separate clocks for secondary, wrong-carrier, and late-enrollment Medicaid claims.

Professional Claims vs. Inpatient Facility Claims

Presbyterian counts a CMS-1500 professional claim from the date of service and a UB-04 inpatient claim from the discharge date. Receipt controls, so clearinghouse rejections and holds count against you. If your coder parks a Turquoise Care claim on a coding query until day 80, you've got 10 days left to send it.

Claims First Sent to the Wrong Carrier

Presbyterian gives you three months from the other carrier's denial letter or EOP date to submit a wrong-carrier claim, or 90 days for Turquoise Care. Send that denial or explanation of payment (EOP) with the claim. CARC 109 on the other payer's remittance marks a claim that belongs with another payer.

If a member didn't tell you about the coverage, Presbyterian requires proof: a patient information sheet showing no insurance, or written communication from the member. Turnover in your billing office doesn't qualify. Your front desk heads off wrong-carrier claims by confirming coverage at check-in, a step we run through our benefit verification services.

Secondary Claims When Presbyterian Pays Second

Presbyterian requires secondary (COB) claims within 90 days of the primary carrier's EOP date, capped at 210 calendar days from the date of service. Attach the primary EOP or denial, because Presbyterian denies COB claims without one. Your Presbyterian timely filing limit is whichever date comes first.

Worked example: secondary claim deadline for a January 10, 2026 date of service

In the second row, a slow primary payer left you 19 days to file. Original Medicare follows another route. Presbyterian receives the Medicare crossover file from CMS, so don't send the same claim to both payers.

Retroactive Eligibility and Late Medicaid Enrollment

If you weren't enrolled with NM Medicaid on the date of service, Presbyterian allows 90 calendar days from the PPA approval notice. Presbyterian judges timeliness by the Medical Assistance Division (MAD) approval date on the Medicaid file. The window can't run past 210 calendar days from the date of service. Our NM Medicaid provider enrollment guide covers the YES.NM.GOV steps.

For retroactive member eligibility, New Mexico's Medicaid billing rule, 8.302.2.11 NMAC, allows 90 days from the date MAD adds eligibility to its record. Ask Presbyterian whether it applies that date and whether it wants Medicaid delay reason codes or the eligibility notice with the claim. Log both 90-day deadlines on your 2026 timely filing calendar.

Presbyterian Corrected Claim Timely Filing Limit: 12 Months From the Date of Service

The Presbyterian corrected claim timely filing limit is 12 months from the date of service. Presbyterian Health Plan's 2026 Universal and Turquoise Care manuals set that window for resubmissions, corrections, and adjustment requests. The first claim must have met its own deadline. After 12 months, Presbyterian upholds its original decision.

You can't use a correction to cure a late first claim. If your resubmission reaches Presbyterian after the three-month or 90-day window, include proof that you filed the original on time. A regenerated claim doesn't count as proof. For electronic claims, save the exception report from Presbyterian or your clearinghouse.

How to Send a Corrected Claim to Presbyterian

Presbyterian accepts electronic corrections to 837 professional and institutional claims, per page 19-2 of the Universal manual. Enter resubmission code 7 or 8 in Loop 2300 of the 837, or in box 22 of the CMS-1500. Put the original claim number in the "Original Ref. No." field. UB-04 claims carry the facility bill type.

1. Rebill all lines from the original claim along with the corrected line.
2. Resubmit the existing claim with code 7 to replace it or 8 to void it; don't create a new claim.
3. For a coordination of benefits (COB) correction, attach the primary payer's EOP. The Universal manual gives COB adjustment requests 90 days from that EOP's date.

Presbyterian's documents conflict on format. A heading on page 19-21 of the Universal manual calls resubmissions and corrections "only acceptable as paper claims." Page 19-2 allows electronic corrections, and Presbyterian's claims processing tips call for electronic resubmission. Before you send a batch, confirm the format with your Provider Network Operations (PNO) relationship team.

Two Corrected Claim Mistakes: Member Not Found and Taxonomy

For a member not found denial, Presbyterian's Universal manual says to verify the member ID and date of birth, then file a new original claim. With no member match on file, a frequency 7 claim has nothing to replace, and Presbyterian denies it again.

Presbyterian's processing tips list a taxonomy that doesn't match the service as a denial reason. Multispecialty groups need the right 10-character taxonomy code on each claim, corrected claims included. If the same taxonomy denial repeats, check the provider setup in your billing system; our denial management services team starts there.

Presbyterian Health Plan Appeal Timely Filing Limit: 12 Months From the Date of Service

The Presbyterian Health Plan appeal timely filing limit is 12 months from the date of service. Both 2026 Presbyterian manuals apply it to appeals of a claim denial, an adjudication, or an unanswered submission or resubmission. Presbyterian resolves provider appeals within 30 calendar days and can request a 14-calendar-day extension.

Why Some Sources Say 60 Days

The 60-day figure comes from an older Presbyterian notice, PPC082211, which gave commercial and Medicaid contracted providers 60 days from the denial date. That PDF ranks near the top of search results. Presbyterian's 2026 manuals and its provider appeals page both say 12 months from the date of service.

Have your AR follow-up team calendar 12 months from the date of service as soon as a denial posts. Next, check the denial letter for a printed appeal deadline. If that deadline falls earlier, appeal by that date and log it in the claim notes.

Overpayment Appeals Use a Second Clock

Presbyterian's Universal manual gives overpayment appeals 12 months from the date of service or 65 days from notification, whichever is later. The Turquoise Care manual sets the notification window at 60 days. Per that manual, Presbyterian recovers overpayments through the EOP as a payment reduction or negative claim payment. Date-stamp each overpayment notice the day it arrives.

Provider Appeals vs. Member Appeals

Presbyterian must receive a member's own appeal within 60 days of the action, according to its member appeals page. Presbyterian's 2026 manual requires the member's written consent before you appeal for a member, unless it's an expedited appeal of a utilization management decision. Track that appeal against the member's 60-day deadline.

Where to Send Presbyterian Appeals

Presbyterian takes provider appeals and grievances by mail, phone, fax, or the Presbyterian appeal form on its provider appeals page. Pharmacies and pharmacists send claim, compliance, and network appeals to Capital Rx, Presbyterian's pharmacy benefit manager. Address mailed appeals to the Provider Grievance Coordinator and keep a dated copy.

• Mail: Presbyterian Health Plan, Attn: Provider Grievance Coordinator, P.O. Box 27489, Albuquerque, NM 87125-7489
• Phone: 1-800-356-2219 (toll-free)
• Fax: (505) 923-6111
• Online: phs.org/providers/resources/appeals-grievances

State your reason for reconsideration and attach support, such as a hard copy of the electronic claim or operative reports for a coding dispute. If Presbyterian hasn't answered after 30 calendar days, use the steps you'd take to follow up on unpaid claims.

Commercial Plan Grievances: 90 Days From the Incident

On Presbyterian commercial plans, providers have 90 days from an incident to file a grievance over claim payment amount, payment timing, or submission requirements. Presbyterian decides within 45 calendar days after its committee has all the information. You can ask the New Mexico superintendent of insurance for review within 30 days of that written decision.

If Presbyterian denials sit in a queue without an owner, the 12-month window can close before anyone appeals. We work appeals and AR follow-up as part of medical billing at 2.99% of collections, all-inclusive, with no setup fees.

Proof of Timely Filing Presbyterian Accepts

Presbyterian Health Plan accepts computer ledgers, written logs, and dated call records naming the contact as proof you met the Presbyterian timely filing limit. Electronic claims need the exception report from Presbyterian or your clearinghouse. Presbyterian's 2026 manuals set the proof deadline at 12 months from the date of service.

Your proof has to be legible. It must show the member, the charges in question, the date of service, and the original billed date. Presbyterian can reject documentation it can't link to the claim, so a ledger screenshot without the claim number won't carry much weight.

Phone Calls: Log the Name and Date

Since November 1, 2016, the Presbyterian Customer Service Center hasn't given confirmation or reference numbers for claim status calls. Presbyterian announced the change in its proof of timely filing notice, PPC091609. Write down the representative's name and the call date for each call, or that call won't count as proof.

Which Clearinghouse Reports to Keep

Keep the 277CA for each electronic claim you send Presbyterian, because it reports acceptance or rejection claim by claim. A 999 covers the batch file's X12 format. Presbyterian calls the required electronic proof an exception report, so ask your clearinghouse which of its reports fits.

Page 19-3 of Presbyterian's Universal manual says your clearinghouse should send an acceptance or rejection report within one day of submission. If a rejection shows up, call the clearinghouse within 48 hours. Before you pick from our list of top medical billing clearinghouses, ask each vendor how long it keeps acceptance reports.

Checking Presbyterian Provider Claim Status

Check Presbyterian provider claim status in the myPRES provider portal every 30 to 45 days, the interval Presbyterian recommends. If the portal shows no payment or denial by then, call the Provider Claims CARE Unit at (505) 923-5757 or 1-888-923-5757.

Keep these five items in each Presbyterian claim file through the 12-month proof window:

1. The exception report from Presbyterian or your clearinghouse, with the claim number
2. The 277CA showing Presbyterian accepted the claim
3. A computer ledger or written log entry with the member, charges, date of service, and original billed date
4. Your call log with each representative's name and call date
5. Any EOP or denial letter from Presbyterian or another carrier

Turquoise Care Claims in 2026: Turquoise Claims, Payer ID 77048, and the October 1 Enrollment Rule

Presbyterian Health Plan, a Turquoise Care (New Mexico Medicaid) plan, uses payer ID 77048 in GS03 and NMPHP in Loop 2010BB NM109. Since March 23, 2026, Medicaid claims go through Turquoise Claims, the HCA's single point of entry. Claims with legacy IDs deny; the transition period ended June 15, 2026.

What Changed When Turquoise Claims Went Live

Presbyterian's Turquoise Claims page says the member's last name and date of birth on each Medicaid claim must match the HCA member portal. Send claims through PROVIDERConnect or an approved clearinghouse. If you use another clearinghouse, confirm it has a Conduent connection before you send Medicaid claims.

Watch the taxonomy on Medicaid claims. If a provider has more than one registered HCA provider type, the claim needs the taxonomy that matches the service. Presbyterian's Turquoise Claims FAQ lists UMD0291 for claims from a non-NMHCA trading partner and CARC 109 with RARC N418 for misrouted claims. R0 applies to Magellan Behavioral Health claims.

The ORP Enrollment Rule Starting October 1, 2026

Since October 1, 2026, payers deny Medicaid claims when an unenrolled provider rendered, ordered, or prescribed the service, under the HCA's ORP rule. ORP stands for ordering, referring, prescribing, and attending providers. Covered providers include pharmacists, group clinicians, hospital systems, facilities, behavioral health agencies, Indian Health Services, and organizational providers.

Presbyterian's Medicaid enrollment guidelines say it rejects and denies claims when an individual or group lacks HCA enrollment or has the wrong provider type. It recoups payments when a provider wasn't enrolled. For Blue Cross and Blue Shield of New Mexico, see our BCBSNM Turquoise Care enrollment guide.

Why Turquoise Claims Rejections Eat Your 90 Days

The Presbyterian Turquoise Care timely filing limit is 90 days from the date of service, and rejections don't pause it. A clearinghouse rejection on day 70 leaves you 20 days to fix and resend the claim. The Presbyterian Medicaid timely filing limit leaves little room for a second rejection.

Update your clearinghouse payer setup to 77048 and NMPHP, and check the first batch's acknowledgments the same day. Next, watch the first remits for the FAQ's denial codes. One payer setup mistake repeats across a full batch, putting each claim at risk under the Presbyterian timely filing limit.

Before you bill Turquoise Care, confirm Medicaid enrollment for each rendering, ordering, referring, and prescribing provider on the claim. MedSole RCM files Medicaid and MCO applications within 48 hours of receiving complete documents, with weekly follow-ups. Our provider enrollment and credentialing starts at $99 per payer application.

Presbyterian Medicare Advantage Plans End December 31, 2026: Filing Your Run-Out Claims

Presbyterian's Senior Care HMO and HMO-POS Medicare Advantage plans end December 31, 2026. Claims with 2026 dates of service stay with Presbyterian. In-network providers have three months from the date of service, the Presbyterian timely filing limit in the 2026 Universal manual. For a visit on December 31, 2026, Presbyterian must receive the claim by March 31, 2027.

Which Presbyterian Plans End and Which Continue

Presbyterian's Medicare Advantage changes page lists seven plans ending December 31, 2026:

• Presbyterian Senior Care Plan 1 (HMO)
• Presbyterian Senior Care Plan 2 w/Rx (HMO)
• Presbyterian Senior Care Plan 3 w/Rx (HMO)
• Presbyterian Senior Care Extra Health Plan w/Rx (HMO)
• Presbyterian Employer Group 4 Plan (HMO-POS)
• Presbyterian Senior Care (HMO-POS) NMRHCA Group Medicare Advantage Plan
• Presbyterian Senior Care (HMO-POS) The University of New Mexico (UNM) Premier and Select Plan

Members who don't choose a new plan move to Original Medicare on January 1, 2027, without Part D drug coverage. Presbyterian Dual Plus (HMO D-SNP) continues in 2027, according to Presbyterian's June 2026 announcement. The list doesn't include Presbyterian MediCare PPO, so confirm its 2027 status with Presbyterian.

Inpatient Stays That Cross January 1, 2027

Under 42 CFR 422.318, a Medicare Advantage organization stays responsible for inpatient services until discharge if coverage ends mid-stay. The rule lists subsection (d) hospitals, psychiatric and rehabilitation hospitals, distinct-part rehabilitation units, and long-term care hospitals.

Take a patient admitted December 28, 2026, and discharged January 5, 2027. The hospital bills Presbyterian for the full stay. Under Presbyterian's 2026 Universal manual, the three-month Presbyterian Medicare Advantage timely filing limit starts at discharge. Presbyterian must receive that facility claim by April 5, 2027.

The Front-Desk Step for January 2027

Former Senior Care members need a new eligibility check at their first 2027 visit. A biller working from a stale Presbyterian card sends 2027 claims to the wrong carrier. Have the front desk verify 2027 coverage and load the new payer and member ID before you bill.

Presbyterian Payer IDs, Claims Addresses, and Provider Contacts

Presbyterian Health Plan's payer ID depends on your clearinghouse. The 2026 Universal manual lists PREHP for commercial claims and PRESA for Medicare Advantage on Availity. For Turquoise Care, use 77048 with NMPHP on each approved clearinghouse. Paper claims go to P.O. Box 27489, Albuquerque, NM 87125-7489.

Presbyterian payer IDs by clearinghouse (2026 Universal Manual, p. 18-6)

Manual revision F, dated July 21, 2026, lists payer ID updates in its revision table. Check your clearinghouse's Presbyterian payer ID setup against page 18-6. Lower-volume practices can key claims at no cost in FastClaim, the direct-entry portal on that page. You'll find its Claim.MD web address on page 19-1.

Claims Mailing Address and Paper Claim Rules

Send new, resubmitted, and corrected paper claims to Presbyterian Health Plan, P.O. Box 27489, Albuquerque, NM 87125-7489. Use the CMS-1500 (02-12) for professional claims; Presbyterian won't take any other version. Facilities bill on the UB-04. For billed amounts of $100,000 or more, attach full itemization and the medical record.

Presbyterian reimburses clean electronic claims within 30 days of receipt, per page 19-2 of the 2026 Universal manual. Clean paper claims get 45 days. Mail time counts against the Presbyterian timely filing limit, because Presbyterian must receive each claim by the deadline.

Payments, ERAs, and the Presbyterian ePayment Center

The Presbyterian ePayment Center handles EFT deposits and 835 remittance files. Register at presbyterian.epayment.center/registration, or call 1-855-774-4392 with setup questions. Our payment posting services team matches each ERA to its claim and flags underpayments for follow-up.

Presbyterian Provider Phone Numbers

Presbyterian's 2026 Universal manual and its claims payment and submission page list these Presbyterian Health Plan provider phone numbers and links:

• Provider Claims CARE Unit: (505) 923-5757 or 1-888-923-5757
• Eligibility by phone (IVR): same numbers, option 1
• PNO e-business analyst for electronic claims and FastClaim: (505) 923-6154
• Provider Network Operations relationship teams: phs.org/ContactGuide

For Presbyterian provider claim status, log in to the myPRES provider portal, which Presbyterian keeps open 24 hours a day, seven days a week.

What Happens After a Presbyterian Timely Filing Denial

The X12 claim adjustment reason code for timely filing is CARC 29: "The time limit for filing has expired." Presbyterian Health Plan's 2026 manuals allow 12 months from the date of service to appeal. Work a Presbyterian timely filing limit denial only with proof of on-time filing or an exception.

Three Paths After a Presbyterian CO-29 Denial

Sort each CO-29 denial (CARC 29 with group code CO) into one of three paths before your denial management team works it:

1. You've got proof of on-time filing: appeal within 12 months of the date of service and attach the exception report or call log.
2. An exception clock applies: refile with the wrong-carrier EOP, PPA approval notice, or primary EOP. Presbyterian caps COB and PPA claims at 210 days from the date of service.
3. Neither applies: adjust the balance off as a timely filing write-off and fix the step that caused it.

Can You Bill the Patient for a Presbyterian Timely Filing Denial?

For Presbyterian Turquoise Care members, no. Subsection G of 8.302.2.11 NMAC, New Mexico's Medicaid billing rule, bars billing the member when a claim denies for a missed timely filing requirement. The G(1) exceptions, an ineligible member or a signed noncoverage statement, don't fit a filing miss.

For commercial and Medicare Advantage members, check the hold-harmless terms in your provider agreement and Chapter 15 of Presbyterian's Universal manual. Presbyterian's manual says you may bill the member for applicable copays, coinsurance, and deductibles. Until your contract says otherwise, treat the remaining balance as your loss.

Timely Filing Waivers: The 2024 Change Healthcare Example

New Mexico OSI Order 2024-0015 (March 20, 2024) made major medical insurers waive timely filing deadlines for claims and appeals. Per Presbyterian's Change Healthcare notice, the order covered non-hospital-affiliated physicians, physician groups, practices, and facilities for services from February 21, 2024. Don't expect a waiver on a routine late claim.

How New Mexico Practices Stay Inside Presbyterian Deadlines

Practices that keep Presbyterian Health Plan claims current work a fixed schedule from the date of service. They submit within three days, check myPRES at day 30, call the CARE Unit by day 45, and escalate by day 60. On that schedule, you can fix and resend one rejected claim inside the Presbyterian timely filing limit.

A Day 0 to 90 Presbyterian Claim Workflow

1. Day 0: Read the product on the ID card and confirm eligibility before the visit.
2. Days 1 to 3: Submit the claim and save the 999, the 277CA, and the exception report.
3. Day 30: Check claim status in myPRES.
4. Day 45: Call the CARE Unit if nothing has posted, and log the representative's name and the date.
5. Day 60: Send any claim without a decision to your PNO relationship team.
6. Day 75: Fix and resend any rejected or unaccepted Turquoise Care claims before the 90-day limit.
7. Secondary claims: Calendar the 90-day EOP date and the 210-day cap the day the primary EOP arrives.

Each rejected submission costs you days. A wrong payer ID or a missing taxonomy sends a Presbyterian claim back to you. The clock keeps running while you fix it. Our claims submission services team scrubs claims for those errors before they go out.

When It Makes Sense to Hand Presbyterian Claims to a Billing Team

If more than a handful of Presbyterian claims age past day 60 each month, look at the workflow before you add staff hours. In our experience, the cause is one person juggling front desk, posting, and follow-up, so the day 30 and day 45 checks slip first.

If you're comparing third party medical billing companies, ask three questions: what percentage they charge, what that fee includes, and whether setup fees apply. MedSole RCM charges 2.99% of collections for medical billing, all-inclusive, with no setup fees. Provider enrollment and credentialing starts at $99 per payer application.

To see where your Presbyterian claims are aging, start with a practice audit, or hand the full cycle to our outsourced medical billing services.

How Presbyterian Compares With Other New Mexico Payers

Presbyterian's three-month commercial window is half the 180 days BCBSNM gives commercial claims, and a quarter of Original Medicare's 12 months. Turquoise Care claims run on 90 days at Presbyterian and BCBSNM, matching the state rule. Federal rules at 42 CFR 447.45 cap any state Medicaid timely filing limit at 12 months.

Initial claim timely filing limit by New Mexico payer (2026)

The BCBSNM Medicaid Provider Reference Manual and Novitas timely filing requirements back two of those rows. For other plans your patients carry, see our BCBS timely filing limits by state and our UHC timely filing rules for 2026. Our Molina timely filing limit guide breaks deadlines down by state.

Medical billing time limits by state and by payer don't line up, so a practice billing four New Mexico payers needs four clocks. Build the payer, product, and window into your billing system's claim aging report.

Presbyterian Timely Filing Limit FAQ

What is the timely filing limit for a Presbyterian Health Plan claim?

The Presbyterian Health Plan timely filing limit is three months from the date of service for in-network commercial and Medicare Advantage claims. Turquoise Care claims get 90 days, and inpatient claims count from discharge. Corrections get 12 months from the date of service.

The Presbyterian Health Plan appeal timely filing limit is 12 months from the date of service as well. Group PPO claims follow the same Presbyterian insurance timely filing limit.

Is Presbyterian New Mexico Medicaid?

Presbyterian Health Plan is one of four Turquoise Care managed care organizations in New Mexico Medicaid. The others are Blue Cross and Blue Shield of New Mexico, Molina Healthcare of New Mexico, and UnitedHealthcare Community Plan. New Mexico's HCA runs Turquoise Care, which replaced Centennial Care on July 1, 2024. Presbyterian Turquoise Care claims follow a 90-day filing limit.

What is the payer ID for Presbyterian Turquoise Care?

Presbyterian Turquoise Care claims use payer ID 77048 in segment GS03 and NMPHP in Loop 2010BB, NM109. Send them through PROVIDERConnect or an approved clearinghouse. Presbyterian has required these IDs since Turquoise Claims launched on March 23, 2026, and claims with legacy payer IDs deny.

What is the payor ID for Presbyterian Health Plan?

Presbyterian Health Plan's payer ID depends on your clearinghouse. On Availity, Presbyterian's 2026 Universal manual lists PREHP for commercial and PRESA for Medicare. Other clearinghouses use Z0003 and Z0077 (nThrive), 05003 (Change Healthcare), and PRESB (Claim.MD). Medicaid claims use 77048 with NMPHP on all four. Check page 18-6 before you update your payer table.

What is the timely filing limit for New Mexico Medicaid?

Under 8.302.2.11 NMAC, New Mexico Medicaid requires claims within 90 calendar days of the date of service. Inpatient stays count from discharge. Secondary claims get 90 days from the other payer's payment or denial, capped at 210 days from the date of service. Federal rules at 42 CFR 447.45 cap any state at 12 months.

Is Presbyterian dropping Medicare Advantage?

Presbyterian is ending its Senior Care HMO and HMO-POS Medicare Advantage plans on December 31, 2026. In June 2026, Presbyterian announced that Dual Plus (HMO D-SNP) continues. Claims with 2026 dates of service stay with Presbyterian under the three-month rule. Under 42 CFR 422.318, Presbyterian stays responsible through discharge for qualifying inpatient hospital stays that cross January 1, 2027.

Can you bill a patient for a Presbyterian timely filing denial?

You can't bill Turquoise Care members for it. Subsection G of 8.302.2.11 NMAC bars billing a member when a claim denies for a missed timely filing requirement. For commercial and Medicare Advantage members, check your provider agreement and Chapter 15 of the Universal manual. Unless your contract says otherwise, write off the balance.

How much does it cost to outsource Presbyterian billing and credentialing?

MedSole RCM charges 2.99% of collections for medical billing, all-inclusive, with no setup fees. Provider enrollment and credentialing starts at $99 per payer application, and our team files applications within 48 hours of receiving complete documents. Both services are part of our revenue cycle management work for practices that bill Presbyterian, BCBSNM, Molina, and New Mexico Medicaid.

Sources and How We Verified This Guide

The MedSole RCM claims team checked each deadline in this guide on October 4, 2026, against Presbyterian's 2026 Universal and Turquoise Care provider manuals. Presbyterian dated both manuals July 21, 2026 (revisions F and C).

We'll update this page when Presbyterian issues a new manual revision, the HCA changes a Medicaid rule, or the 2027 Medicare Advantage changes take effect.

• 2026 Universal Practitioner and Provider Manual, Presbyterian Health Plan
• 2026 Turquoise Care Practitioner and Provider Manual, Presbyterian Health Plan
• Turquoise Claims and the Turquoise Claims FAQ, Presbyterian Health Plan
• Providers Appeals and Grievances, Presbyterian Health Plan
• Changes to Presbyterian Medicare Advantage Plans, Presbyterian Health Plan
• 8.302.2.11 NMAC, Billing and Claims Filing Limitations, New Mexico Administrative Code
• ORP Requirements, New Mexico Health Care Authority
• 42 CFR 447.45 and 42 CFR 422.318, Electronic Code of Federal Regulations
• Claim Adjustment Reason Codes, X12