Timely Filing Limit 2026: Deadlines by Payer and State, Cited to Source

Quick answer: A timely filing limit is the deadline a payer gives you to get a claim into its system after the date of service. In 2026, Original Medicare allows 12 months. Federal rules cap Medicaid at 12 months, and many states set less: Texas allows 95 days, New York 90. Commercial contracts run 90 to 180 days.

Four things decide which deadline applies to a claim: the payer, the plan type, your network status, and the claim type.

Timely filing limits by payer type, verified October 2026

What Is a Timely Filing Limit?

A timely filing limit is the maximum time a payer allows between the date of service, or discharge, and its receipt of a clean initial claim. Payers enforce it as a hard stop. The clock runs until the payer receives your claim, so the day you hit send doesn't count.

Timely filing sounds like a back-office detail. It decides whether the payer looks at your claim at all. You can code a visit without a single error, attach the records, and still lose the money because the claim landed one day late.

A medical timely filing limit works the same way for a two-provider dermatology office and a 300-bed hospital. Each payer sets a time limit for insurance claim submission, and your job is to know which one applies before the claim ages.

What Does TFL Mean in Medical Billing?

TFL in medical billing is shorthand for timely filing limit. You'll see the acronym on payer grids, clearinghouse reports, and denial notes. The Medicare TFL limit is 12 months from the date of service, with four narrow exceptions written into federal regulation.

Search Google for "TFL for Medicare" and you'll often get TRICARE For Life first. TRICARE For Life is wraparound coverage for military retirees who have Medicare, and it pays after Medicare does. The acronym overlaps, so confirm which one a coworker means before you look up a deadline.

Timely Filing Limit vs. Appeal Deadline vs. Prompt Pay

Billers mix up three clocks on the payer grids you'll find online. Each one binds a different party and starts at a different moment.

Three different claim clocks

Mixing them up costs you claims. Several guides cite 42 CFR 422.520 as a Medicare Advantage filing deadline, but that rule tells plans how fast to pay. It says nothing about when you must file. Timely documentation, meaning charting soon after the visit, is a separate compliance standard with its own rules.

What Happens When a Claim Misses the Window

The payer denies the claim with CARC 29, which X12 defines as "The time limit for filing has expired." On your remittance, it shows up as CO-29. Its "CO" group code means contractual obligation, so the write-off stays with your practice instead of moving to the patient.

Expect your in-network contract to bar you from billing the patient for a late claim you caused. Medicare.gov tells beneficiaries that Medicare won't pay its share when a provider files late, and you won't recover much from a timely filing denial once it posts.

Picture a practice billing $2 million a year in charges. If late filing eats 1% of that, the practice writes off $20,000 for paperwork, with nothing wrong in the care itself. That figure is an example, but billing managers who track CO-29 dollars find their own number fast.

Late filing shows up on lists of top claim denial reasons because no coding fix can rescue it. Practices that use outsourced medical billing treat filing windows as a number on a weekly report, instead of something one biller keeps in her head. Once someone owns that report, timely filing limits show up on the calendar weeks before they bite.

Why Timely Filing Limits Differ by Payer

There is no single national timely filing limit. Four documents set deadlines: federal regulation for government programs, state law for Medicaid and fully insured plans, the payer manual as the published default, and your provider agreement, which has the final word for many contracted claims.

You'll see 90, 180, and 365 days on the same search results page for that reason. Each number can be right for one plan and wrong for yours, and a billing team that copies a grid from the internet inherits the mistakes on it.

The Four Documents That Set Your Deadline

1. Federal regulation. 42 CFR 424.44 sets Original Medicare at 12 months, 42 CFR 447.45 caps Medicaid fee-for-service at 12 months, and separate federal rules govern TRICARE and CHAMPVA.
2. State law. State Medicaid manuals set fee-for-service windows, and some state insurance codes set minimum windows for fully insured commercial plans.
3. Payer manuals and policies. These hold the published default for providers whose contracts say nothing different.
4. Your participation agreement. The signed contract can shorten or extend the default, and it controls where it differs.

Check them in that order when you build timely filing deadlines into your billing calendar. If two documents disagree, the signed contract settles it for most in-network claims, and state or federal law sets the floor underneath.

When Your Contract and the Payer Manual Disagree

Payers say this in their own documents. Cigna's claims policy lists exceptions to its 90-day and 180-day defaults, including state law, your contract, and coordination of benefits. UnitedHealthcare's 2026 administrative guide tells providers to "refer to your internal contracting contact or Participation Agreement for timely filing information."

Wellpoint's timely filing policy says a contract or law can override its published windows. Before you put a deadline on the calendar, pull the claims submission clause from your executed contract. A payer grid from a vendor website won't hold up in a dispute, and your signed agreement will.

Self-Funded Plans Follow the Plan Document

Third-party administrators such as UMR and Meritain Health process claims for self-funded employer plans. UMR's provider guide says timely filing requirements come from "the self-funded customer, as well as the provider-contracted timely filing provisions." Our page on UMR timely filing rules shows where to find each one.

Meritain works the same way. The employer's plan document and your network agreement set the window, so you won't find one universal number to memorize. Our breakdown of Meritain plan document deadlines covers how to request the right document.

In most cases, state insurance filing laws don't reach self-funded plans governed by ERISA. A state rule from the next sections may not apply when the member's coverage is self-funded, so check the ID card or the eligibility response before you rely on state law.

How the Timely Filing Clock Is Counted

Each timely filing limit has a start event and an end event. In most cases the start is the date of service, or the discharge date for inpatient care. The payer's receipt date marks the end. Count calendar days unless the payer's rule says otherwise.

Which Date Starts the Clock

Medicare spells out the start date in the CMS Claims Processing Manual, Chapter 1. Part B claims count from the line-item "From" date, while Part A institutional claims with span dates count from the "Through" date. Other payers set their own triggers, and the table shows the common ones.

What starts the filing clock, verified October 2026

Get the start date wrong and the deadlines after it shift. Count a three-week inpatient stay from admission instead of discharge, and you give up three weeks of a window you were entitled to use.

Received, Not Sent

Medicare counts the date the correct Medicare Administrative Contractor (MAC) receives the claim. If you send it to the wrong MAC, your clearinghouse rejects it, or the MAC returns it to provider (RTP), Medicare doesn't treat the claim as filed. The clock keeps running the whole time.

Clearinghouse acceptance isn't payer acceptance. Your electronic claim submission report can show green checkmarks while the payer has no record of the claim. Pull the payer's own acknowledgment, the 277CA, before anyone on your team calls a claim filed.

Weekends, Holidays, and Leap Days

Medicare has a written roll-forward rule. Under 42 CFR 424.44(c), a deadline that falls on a federal nonworkday moves to the next workday. A February 28, 2026 date of service has a deadline of February 28, 2027. That date is a Sunday, so the deadline moves to Monday, March 1, 2027.

Leap days run the other way. Medicare wants a claim for a February 29 date of service by February 28 of the following year. Commercial payers may not roll weekends forward at all, so file before the weekend unless the payer's written policy says otherwise.

Worked Example: One Date of Service, Six Deadlines

Take one date of service, March 2, 2026, and run it through six common windows. The timely filing limit lands on a different weekday each time, and two of the six fall on a weekend.

Six deadlines for a March 2, 2026 date of service (computed and checked October 2026)

If your team can't say which date starts each payer's clock, fix that before the next denial lands. MedSole RCM runs full-service billing at 2.99% of monthly collections, and payer-by-payer deadline tracking is part of that work.

Medicare Timely Filing Limit: 12 Months From the Date of Service

Under 42 CFR 424.44, Original Medicare requires claims to reach the correct MAC no later than 1 calendar year after the date of service. The Medicare timely filing limit hasn't changed for 2026. CMS asked in a February 2026 request for information whether to shorten it for certain high-risk items, and that request didn't change the regulation.

Where the 12-Month Rule Comes From

Section 6404 of the Affordable Care Act set the 12-month limit for services furnished on or after January 1, 2010. CMS Transmittal 2140 put the change into the claims manual. Before 2010, providers had between 15 and 27 months, depending on when in the year the service fell.

Two details trip up billing teams. Billing a primary payer first doesn't extend Medicare's clock when Medicare is secondary. A claim sent to the wrong contractor doesn't count until the correct MAC receives it, so it pays to know how MACs process claims in your jurisdiction.

Medicare timely filing runs on the calendar, whatever your billing cycle looks like. CMS's Medicare timely filing guidelines in Chapter 1 of the claims manual count to the anniversary of the service date, and timely filing for Medicare doesn't pause for holidays except under the nonworkday rule.

The Four Exceptions That Extend the Deadline

Medicare extends the timely filing limit in four situations, all listed in 42 CFR 424.44(b). You'll need documentation for any of them. The extension runs through the last day of the sixth calendar month after a triggering event, and your MAC decides whether you qualify.

Medicare timely filing exceptions under 42 CFR 424.44(b), verified October 2026

CMS won't grant an administrative-error extension more than four years after the date of service. Natural disasters aren't one of the four exceptions. Disaster relief comes through separate waivers when CMS issues them, so don't build a reopening request around a storm alone.

Why a Late Medicare Claim Can't Be Appealed

A Medicare timely filing denial isn't an initial determination, so the appeal process never opens. Federal regulation lists "determinations that a provider or supplier failed to submit a claim timely" among the actions that aren't initial determinations, in 42 CFR 405.926(n).

Your only route is a reopening request, and only when you can document one of the four exceptions. You'll see CO-29 on Part B remittances and remark code N390 on Part A institutional claims. Our guide to Medicare timely filing rules walks through the reopening steps.

Medicare Advantage Timely Filing Limits Come From Your Contract

Medicare Advantage plans don't follow Original Medicare's 12-month rule. If you're contracted, your participation agreement sets the window, often 90 to 180 days. Noncontracted rules come from each plan's own policy. Wellpoint, for example, gives non-participating providers 12 months and participating providers 90 days.

Is There a 365-Day CMS Floor? No.

There is no 365-day CMS filing floor for Medicare Advantage. 42 CFR 422.520 is the Medicare Advantage prompt payment rule. It requires plans to pay 95% of clean claims from noncontracted providers within 30 days, and it says nothing about when you must file.

Several guides and AI summaries still describe a 365-day CMS floor. A practice that believes it and holds claims for a plan with a 90-day contract loses those claims in month four. No appeal fixes that, because the contract set the window and the practice missed it.

Contracted vs. Noncontracted Providers

For contracted providers, the agreement controls the timely filing limit, and it can be shorter than the plan's published default. HealthSpring's 2026 participating provider manual, for one, sets 180 days from the initial date of service unless your agreement says otherwise. Noncontracted claims follow the plan's published policy.

Record network status per plan, per provider, and per product. A physician can be in-network for a plan's HMO and out-of-network for its PPO, and the two windows won't match. Appeals run on their own clocks, separate from filing.

Medicare Advantage Limits by Plan (2026)

UnitedHealthcare sets the UHC Medicare Advantage timely filing limit through your Participation Agreement, and AARP plans run on those same UHC terms. Humana's 2026 manual puts the Humana Medicare timely filing limit at 1 year from the date of service unless your agreement or the law says otherwise.

For Aetna, the Aetna Medicare Advantage timely filing limit follows the plan and your contract. Blue plans vary, so the BCBS Medicare Advantage timely filing limit depends on which independent Blue company you bill. Anthem's is 90 days for professional claims with dates of service on or after October 1, 2019.

Medicare Advantage timely filing by plan, verified October 2026. Your contract controls.

Tracking a separate contract window for each Medicare Advantage plan is where practices slip. MedSole's team works aging claim follow-up by days left on the clock, so a claim with 12 days left goes to the front of the queue ahead of a bigger claim with 80.

Medicaid Timely Filing Limit: A Federal Ceiling of 12 Months, Shorter State Rules

Federal rules require state Medicaid agencies to make providers submit claims within 12 months of the date of service, under 42 CFR 447.45. States can set shorter windows, and 16 programs do: Texas allows 95 days, while New York and Massachusetts allow 90. Medicaid managed care plans set their own limits through state contracts.

The 12-Month Federal Ceiling in 42 CFR 447.45

The regulation tells states to require providers to submit claims "no later than 12 months from the date of service." Read that as a ceiling on state rules. It doesn't promise you 12 months in any state, and a Pennsylvania or Illinois biller who assumes it will lose claims at day 181.

Section 447.45 also holds the prompt pay standards for state agencies: pay 90% of clean claims within 30 days of receipt and 99% within 90 days. That's the agency's clock. Guides that quote it as your filing deadline get timely filing for Medicaid backward.

There's No Federal 90-Day Minimum

Some guides describe a federal 90-day floor for Medicaid. Federal Medicaid rules set no minimum, so each state picks its window anywhere under the 12-month ceiling. State Medicaid timely filing guidelines we checked in October 2026 ran from 90 days to 12 months.

Searches for the Medicaid TFL limit want one number, and there isn't one. The gap between a 90-day state and a 12-month state is the timely filing limit mistake I see most in multistate groups, where one billing team covers clinics in several programs.

Exceptions That Allow Payment After 12 Months

Federal rules list four situations, in 447.45(d)(4), where a state may pay a claim after the 12-month ceiling has passed:

1. Retroactive adjustments paid under a retrospective payment system.
2. Medicare crossover claims, which a state may pay within 6 months of receiving notice of the Medicare disposition, as long as you filed the Medicare claim on time.
3. Claims from a provider under investigation for fraud or abuse.
4. Payments that carry out a court order, a hearing decision, or a corrective action.

Retroactive eligibility isn't on that federal list. States handle it in their own rules. New York uses delay reason codes, Maine gives 1 year from the date it grants eligibility, and Montana counts 12 months from the latest of the service date or the eligibility decision.

Medicaid Managed Care Plans Set Their Own Windows

Managed care adds another layer. The Medicaid timely filing limit for a Medicaid managed care organization (MCO) comes from its state contract and provider manual, so two plans in the same state can give you different windows for the same service.

Medicaid managed care timely filing examples, verified October 2026

New Mexico adds its own wrinkle with Turquoise Care, and our page on Presbyterian Turquoise Care rules covers that plan's claim, correction, and appeal windows.

Enrollment status matters as much as the window. A provider who isn't enrolled can't get paid, but the filing clock still runs from the date of service. Finish Medicaid provider enrollment before the first visit, or you'll spend half the window waiting on paperwork.

Medical Billing Time Limits by State (2026)

Payers set most filing limits, but state rules matter in two places: Medicaid fee-for-service programs, and state insurance laws that set minimum filing windows for fully insured commercial plans. Medical billing time limits by state vary more than most billers expect. Self-funded ERISA plans fall outside those state insurance laws in most cases.

Texas Medicaid Timely Filing Limit and Texas Commercial Plans

The Texas Medicaid timely filing limit is 95 days from each date of service, per the TMHP claims filing manual. TMHP must receive appeals within 120 days of the disposition date on the Remittance and Status (R&S) Report.

If Medicare pays first, TMHP must receive the Medicaid claim within 95 days of the Medicare disposition date. TMHP timely filing counts the day TMHP receives your claim, so a claim you mailed on day 94 can still miss. Our walkthrough of Texas Medicaid enrollment covers the step that has to come first.

Texas commercial plans follow 28 TAC 21.2806, which requires claims to a managed care carrier within 95 days of the date of service. Institutional providers count from discharge. A secondary claim's clock starts when you receive notice of the primary payer's payment or denial, and a contract can give you more time.

California Timely Filing Limits: Medi-Cal and Commercial Plans

The Medi-Cal timely filing limit is six months following the month of service, judged by the through date, per the Medi-Cal claim submission manual. Medi-Cal pays late claims at 75% in months seven to nine and 50% in months 10 to 12, then denies them unless an approved delay reason applies.

Commercial plans regulated by the Department of Managed Health Care follow 28 CCR 1300.71. Subsection (b)(1) bars filing deadlines shorter than 90 days for contracted providers and 180 days for non-contracted providers, counted from the date of service or, for inpatient care, discharge.

Anyone hunting for one timely filing limit California applies across all payers won't find it. The 90-day and 180-day figures are floors, so a contract can give you more time, and Medi-Cal runs on a separate month-of-service clock.

New York Timely Filing Limits: eMedNY and Insurance Law 3224-a

New York Medicaid requires initial submission within 90 days of the date of service under 18 NYCRR 540.6, as the eMedNY Guide to Timely Billing explains. Delay reason codes let you file later when the delay was outside your control, and claims must reach final submission within two years.

New York Insurance Law 3224-a subsection (g) gives you 120 days for initial commercial claims. Contracts for certain Medicaid managed care programs can set a shorter window, but not under 90 days. Our guide to New York Medicaid enrollment covers getting set up in eMedNY.

Georgia and Florida Medicaid Timely Filing Limits

Georgia Medicaid gives most providers six months from the month of service, according to training material from GAMMIS, the state's fiscal agent. Crossover and secondary claims get 12 months from the month of service. Section 203 of the Georgia Medicaid Part I manual, July 1, 2026 edition, holds the governing text.

If you're checking the timely filing limit Georgia applies, count from the month of service rather than the day, and confirm the date against Section 203. Our guide to Georgia Medicaid enrollment covers GAMMIS setup.

Florida Medicaid requires claims within 12 months of the date of service, per AHCA's provider reimbursement handbook. Crossover claims get the later of 36 months from the date of service or 12 months from Medicare's adjudication date. The timely filing limit Florida managed care plans use comes from each plan's contract, and Florida Medicaid enrollment comes before any of it.

Medicaid Timely Filing Limits for All 50 States and DC

We checked the timely filing limit for each state Medicaid fee-for-service program against the state's own manual, rule, or bulletin in October 2026. Sixteen programs set less than 12 months. The timely filing limit for Medicaid managed care plans in the same state can differ, so treat this table as the fee-for-service baseline.

Medicaid timely filing limit by state, fee-for-service initial claims, verified October 2026

New Hampshire shows why primary sources matter. A grid copied across several billing sites lists 15 months, which would exceed the federal ceiling. That figure is the state's deadline for resubmitting a denied claim, and the initial limit is one year from the earliest date of service.

An unenrolled provider can't bill Medicaid, but the filing clock still runs. MedSole RCM handles Medicaid and commercial enrollment at $99 per payer application and files applications within 48 hours. See how credentialing at $99 per payer works for a new provider.

Timely Filing Limit for All Insurance: 2026 Master Table

No single deadline covers all plans. Commercial payers allow 90 to 180 days under most contracts, Medicare Advantage plans follow your agreement, and government programs follow federal rules: 12 months for Original Medicare, 1 year for TRICARE and CHAMPVA. The table lists 30 payers, each with its controlling source.

Use the table as a starting point, then confirm the timely filing limit in your own contract before you calendar anything. A payer can publish one window and sign a different one with your group, and the signed version wins for your claims.

Timely filing limits by payer, verified October 2026. Your contract controls.

Major Commercial Payers

Commercial windows cluster between 90 and 180 days, and network status often doubles the window. Cigna's Cigna claims policy gives participating providers 90 days after the date of service and out-of-network providers 180 days, with consecutive-day services counted from the last date.

Aetna and UnitedHealthcare point you back to the contract. Aetna's 2026 office manual says claims must arrive within "contractual timeframes," and UHC's guide sends you to your Participation Agreement. Grids that list a flat Aetna or UHC number are guessing at your contract.

Humana announced in February 2023 that it would exit the employer group commercial medical business, so most practices now see Humana as Medicare Advantage or Medicaid. California doesn't require 365 days for commercial claims. Its floor is 90 days for contracted providers and 180 for non-contracted, under 28 CCR 1300.71.

Blue Cross Blue Shield isn't one payer. Each independent Blue company sets its own windows, so the answer runs from 90 days to 1 year depending on the plan and the product. Anthem's New York commercial plans, for example, kept a 120-day window when Anthem moved Medicare Advantage professional claims to 90 days in 2019.

Military and Veterans Coverage: TRICARE, CHAMPVA, and VA Community Care

TRICARE requires claims within 1 year after the services are provided, under 32 CFR 199.7(d). If TRICARE returns a claim for more information, you can resubmit by the later of 1 year after the service or 90 days after the return. TRICARE gives overseas claims 3 years from the date of service or inpatient discharge.

CHAMPVA follows 38 CFR 17.276: 1 year from the date of service, or 1 year from discharge for inpatient care. Retroactive approvals get 180 days from the beneficiary's notice. CHAMPVA pays last, after the other health insurance issues its decision, and VA won't excuse delays caused by provider billing procedures.

The VA timely filing limit depends on the program. Claims for Veterans Community Care, including the Optum-run Community Care Network, are due within 180 days after the date you furnished the care, under 38 U.S.C. 1703D. In a Medicare search, "TFL" tends to mean TRICARE For Life, which pays after Medicare and follows TRICARE's 1-year rule.

What Is the Golden Rule Timely Filing Limit?

Golden Rule Insurance Company is a UnitedHealthcare company that sells individual plans. UnitedHealthcare's 2026 administrative guide places Golden Rule under its UnitedHealthOne Individual Plans supplement, so the window comes from that supplement and your agreement. As of October 2026, we found no separate number published elsewhere.

Several AI summaries say Golden Rule corrected claims get 180 to 365 days from the remittance and that appeals get 65 days. Neither figure appears in UnitedHealthcare's published materials, and UHC's appeals page gives 12 months to complete reconsideration and appeal.

Corrected Claims Run on a Different Clock

A corrected claim doesn't always get a new window. For Original Medicare, CMS CR 12909 (effective November 26, 2024) removed the timely filing period for adjustments and made them subject to administrative finality instead. Commercial payers set their own corrected claim windows, and many tie them to the original timely filing limit.

Medicare Corrected Claim Timely Filing After CR 12909

Medicare corrected claim timely filing changed with Transmittal 12909. The manual now says: "There is no longer a timely filing period for adjustments." Adjustments fall under "the rules governing administrative finality," which means the reopening time limits apply instead of the 12-month filing window.

Two exceptions sit in the same section. You can't use an adjustment to add a new item or service after the initial claim's filing limit has expired. Adjustments that move a claim to a higher-weighted DRG must reach the MAC within 60 days of the original claim's remittance.

Institutional providers under Part A file adjustment bills. Part B professional corrections go through the MAC's reopening process in most jurisdictions, so check your MAC's instructions before you resend a Part B claim as a replacement.

Commercial Corrected Claim Windows Vary by Payer

Commercial payers write their own rules for corrections, and the differences are large. Some fold corrections into the original window, and others add a fixed number of days or count from the remittance. UnitedHealthcare also revised its corrected claim timely filing language in Chapter 10 of the 2026 administrative guide.

Commercial corrected claim windows, verified October 2026

Some summaries give UnitedHealthcare corrected claims 180 or 365 days from the remittance. UHC's own claims page keeps corrections inside the original filing window, so a correction sent on day 200 of a 90-day contract won't save the claim.

Replacement, Void, and Rejected Claims Aren't the Same Thing

Frequency code 7 replaces a claim the payer already adjudicated, and frequency code 8 voids it. Both need the payer's original claim number. Our guide to corrected claim resubmission codes shows where each code goes on the CMS-1500 and the 837.

A rejected claim never entered adjudication, so it goes back as a new claim with frequency code 1. Missing-information denials often force a corrected claim against the clock, and our CO-16 denial fixes page covers that timely filing trap in detail.

Secondary and COB Claims: Does the Clock Restart?

Sometimes. Commercial secondary windows often start when you receive the primary payer's EOB or remittance, depending on the contract and state law. Original Medicare doesn't restart. Medicare as secondary still needs the claim within 12 months of the date of service, whatever the primary payer did.

Medicare as Secondary: No Extra Time

Original Medicare doesn't give secondary claims extra time. The Medicare timely filing limit counts from the date of service even when another payer pays first, under 42 CFR 424.44. Some guides describe a "later of" rule for Medicare secondary claims, and the regulation contains no such rule.

Bill the primary payer within days of the visit, so its decision arrives well inside Medicare's 12 months. If a primary payer sits on a claim for eight months, you have four months left to finish the Medicare claim, and the MAC won't extend that for you.

Medicaid, TRICARE, and CHAMPVA as Secondary

Federal rules let a state pay a Medicare crossover claim within 6 months of the Medicare disposition, if you filed the Medicare claim on time. That's the one place the Medicaid timely filing limit can stretch past 12 months under federal rules, and states set their own crossover windows on top of it.

State crossover windows vary. Maryland gives the later of 12 months from the date of service or 120 days from the Medicare remittance. Washington and Wyoming give six months from Medicare's action, and Texas gives 95 days from the Medicare disposition date.

TRICARE lists delays by other health insurers as an exception under 32 CFR 199.7(d). CHAMPVA pays after the other health insurance issues its explanation of benefits, and VA can grant an exception when the primary's delay isn't the beneficiary's fault. Delays in your own billing process don't qualify.

Commercial Secondary Claims Often Start at the Primary's EOB

Texas writes the EOB rule into law. Under 28 TAC 21.2806, a secondary claim's clock starts when you receive notice of the primary payer's payment or denial. Outside Texas, the secondary payer's contract or manual sets the EOB timely filing limit, so read it before you assume extra time.

Attach the primary EOB or the 835 data to each secondary claim. Post primary remittances the same day you receive them, using EOB and ERA posting that triggers the secondary bill right away, and timely filing on the secondary stops depending on someone remembering it.

A CO-22 denial means the payer thinks another plan is primary. Fix the coordination of benefits record with the patient and both payers before the window closes. Our guide to CO-22 coordination of benefits denials covers the calls to make.

Rejected Isn't Filed: Proof of Timely Filing

Proof of timely filing is a record showing the payer received your claim inside its window. The strongest proof is the payer's own acknowledgment: a 277CA acceptance or a payer claim number. A 999 only shows the file passed format checks, and a rejected claim was never filed while the clock kept running.

Accepted, Rejected, and Denied Mean Different Things

Billers swap these three words in conversation, and the confusion costs claims. Each status tells you something different about whether the payer has your claim and whether your timely filing limit is satisfied.

Claim status and what it means for your deadline

Proof of Timely Filing, Ranked From Strongest to Weakest

Payers decide what proof they accept, so check the manual before you build a packet. In my experience, the ranking below holds across most commercial payers.

1. A payer 277CA showing acceptance, with the payer claim number and date.
2. A payer portal claim status screen showing the receipt date and claim number, saved as a dated screenshot.
3. A payer letter or other correspondence acknowledging receipt.
4. A clearinghouse report showing the payer's acceptance, since clearinghouse acceptance alone isn't enough.
5. A certified mail or courier receipt plus a copy of the claim, for paper claims.
6. A 999 accepted acknowledgment, which is weak because it confirms file syntax only.
7. Your practice management system's "billed" date, which isn't proof at all.

A 999 doesn't prove the payer received anything. Original Medicare goes by the MAC's own receipt date, so proof matters most when you file a commercial reconsideration after a timely filing denial you believe is wrong.

Where Claims Get Lost Before the Payer Sees Them

Lost claims tend to sit in a rejection queue. Your biller sends a claim, the clearinghouse or payer bounces it, and the rejection sits unworked. Strong clean claim submission habits stop that leak at the source.

Payer ID changes cause the next wave. ConnectiCare moved its Marketplace and Medicare claims to Molina's processes and payer ID MLNCT on January 1, 2026. A March 2026 Molina Ohio bulletin moved Marketplace-primary claims with Medicaid secondary to payer ID 0007316.

Claims sent to the wrong MAC and eligibility on file for the wrong plan round out the list. Each one looks "billed" in your system while the payer has nothing. Set up 277CA claim tracking so your team sees payer acceptance by claim, and if your vendor can't return 277CA data, our clearinghouse comparison lists the ones that do.

Missed the Deadline? CO-29, Exceptions, Appeals, and Patient Billing

A claim that misses its timely filing limit comes back denied with CARC 29, shown as CO-29. Original Medicare doesn't allow an appeal; you can request a reopening only if one of four exceptions applies. Commercial payers often allow a reconsideration with proof of timely filing or a documented exception. Billing the patient is off the table in most cases.

What CARC 29 (CO-29) Means

The X12 claim adjustment reason codes define CARC 29 as "The time limit for filing has expired." Group code CO, contractual obligation, puts the loss on the provider. Part A institutional claims may also carry remark code N390.

Don't confuse it with look-alike denials. If your remittance shows CO-197 instead, the problem is a missing authorization, and our page on CO-197 authorization denials covers that fix.

Original Medicare: Reopening, Not Appeal

Under 42 CFR 405.926, paragraph (n), a determination that you failed to submit a claim on time isn't an initial determination. Medicare appeal timely filing rules don't help a late claim, because the appeal process starts with an initial determination and this denial isn't one.

Your route is a reopening request that documents one of the four 424.44(b) exceptions. Administrative-error requests stop at four years after the date of service. Our guide to Medicare CO-29 reopening lays out the request and what to attach.

Commercial Payers: Reconsideration and Appeal Deadlines

The health insurance denial appeal deadline is a separate clock from the filing limit. Miss it, and a denial you could have overturned becomes final. Each payer sets its own, and the table shows the published windows for the payers practices ask about most.

Reconsideration and appeal deadlines, verified October 2026

A reconsideration packet needs the payer's acknowledgment of receipt or exception documentation. Payers consider retroactive eligibility, a primary payer's delay, payer error, and a patient who gave you the wrong insurance, so check the manual for the exact list. An open appeal doesn't pause the filing clock on any other claim, including services you haven't billed yet.

Can You Bill a Patient for Timely Filing Denials?

In most cases, no, because the deadline was yours to meet. In-network contracts make CO-29 a provider write-off, and the "CO" group code on the remittance says the same thing. Medicaid providers must accept Medicaid payment as payment in full, so the Medicaid member isn't a fallback either.

Original Medicare patients get a direct message from Medicare.gov: if a claim isn't filed within 12 months, "Medicare won't pay its share," and the patient should call 1-800-MEDICARE if a provider hasn't filed. Out-of-network commercial claims depend on state balance billing law. A narrow exception exists when a patient withheld insurance information and your contract allows billing in that case.

Some CO-29 denials are recoverable with the right proof, and plenty aren't. MedSole's denial team sorts the two fast and files appeals within 48 hours, so your staff stops chasing claims that can't be won. Start with a timely filing denial recovery review.

What Changed for Timely Filing in 2026

Original Medicare's 12-month rule didn't change in 2026, and 42 CFR 424.44 still reads "1 calendar year" as of October 12, 2026. CMS did publish a February 27, 2026 request for information asking whether to shorten Medicare timely filing for high-risk items such as DMEPOS. Several payers also changed brands, payer IDs, and corrected claim windows.

2026 changes affecting timely filing limits, verified October 2026

The CRUSH request is the item to watch. CMS framed it as a question about fraud-prone supply categories, and it would take a proposed rule, a comment period, and a final rule before your timely filing limit for any Medicare service changes. Check the Federal Register request for information docket before you change a Medicare deadline in your system.

2026 Timely Filing Calendar and Deadline Calculator

Count calendar days from the date of service: 90, 120, or 180 days for most commercial plans, and 1 calendar year for Original Medicare. Medicare moves a deadline that lands on a weekend or federal holiday to the next workday. Commercial payers may not, so file before any weekend date in this calendar.

Timely Filing Calendar 2026: Deadlines for the 15th of Each Month

The timely filing calendar 2026 below uses the 15th of each month as the date of service. Day 1 is the day after the service date. Payers can use a different count, so treat each date as the last safe day and aim to file weeks before it.

Timely filing calendar 2026, verified October 2026. Day 1 is the day after the date of service.

A Saturday or Sunday in the commercial columns means you file by the Friday before. Holidays catch billers too: a January 1, 2026 date of service has a Medicare deadline of January 1, 2027, a federal holiday, so the deadline moves to Monday, January 4, 2027.

Timely Filing Calculator for Medical Claims

Our timely filing calculator for medical claims takes a date of service or discharge date, the payer type, the state, and your network status. It returns the deadline, the weekday, the days remaining, and a file-by date that lands on a business day.

State presets apply medical billing time limits by state for Medicaid fee-for-service, such as 95 days in Texas and six months following the month of service for Medi-Cal. For contracted plans, enter your contract's day count, because no tool can see what your group signed.

The calculator gives an estimate. Your contract and the payer's manual control the final answer, and the Medicare roll-forward applies only to Original Medicare.

The calculator handles one claim at a time. If you want someone to run your open AR against each payer's real window and flag what's about to expire, MedSole RCM will do a deadline review and send you the list.

How to Stop Losing Claims to Filing Deadlines

Missed deadlines trace back to gaps you can see coming: the wrong insurance on file, a provider who isn't credentialed yet, rejections that sit unworked, and AR sorted by dollar size instead of days left. Close those four gaps and you'll cut CO-29 denials at the source.

A Seven-Step Timely Filing Workflow

1. Verify eligibility and coordination of benefits before the visit. Run insurance eligibility checks at scheduling and again at check-in, so the claim goes to the right payer on the first try.
2. Confirm credentialing and effective dates before the provider sees patients. An unenrolled provider can't bill, and provider credentialing services should finish before the first appointment, not after it.
3. Build a payer filing matrix from executed contracts. Record the window by plan, product, and provider, and use the shortest window when you're unsure.
4. Set a charge lag target. Getting claims out within 48 to 72 hours of the visit is a reasonable target, and timely billing is the cheapest protection against a late claim.
5. Work clearinghouse and payer rejections every business day. A rejection sitting in a queue is a claim the payer hasn't received.
6. Sort AR by days left on the filing clock, then by dollars.AR follow-up by deadline puts a $90 claim with nine days left ahead of a $900 claim with 70, and our guide to unpaid claim follow-up shows the call script.
7. Track prior authorizations alongside the claim. A late authorization can push a claim past its window, so tie each authorization to its claim through prior authorization services or your own log.

The 48 to 72 hour charge lag in step 4 is an example target, not an industry standard. Pick a number your team can hit, then measure it weekly.

Set Alerts Before the Deadline, Not After

Set alerts at 30, 14, and seven days before each claim's timely filing limit. Route anything under 30 days to a senior biller, and review the list in your weekly AR meeting instead of waiting for month-end.

Track two numbers each month: the count of CO-29 denials and the dollars written off for timely filing. Measure them against your own baseline. Timely filing deadlines belong on the same dashboard as days in AR, because both tell you how fast your team moves a claim from visit to cash.

What It Costs to Outsource Deadline Tracking

MedSole RCM is a full-service revenue cycle management company that charges 2.99% of monthly collections for medical billing and $99 per payer for provider enrollment and credentialing, with no setup fees and no long-term contracts. Deadline tracking by payer is part of the billing work, along with full revenue cycle support from claim to payment.

What 2.99% Covers

MedSole's billing page describes the rate in four words: "2.99% of collections. Everything included." That covers the work that protects a timely filing limit, from claim submission through payment posting, denial management, and AR follow-up. MedSole submits claims within 24 hours and files appeals within 48 hours.

Most medical billing companies charge between 4% and 7% of collections. On $50,000 in monthly collections, 2.99% comes to $1,495, while a 7% rate costs $3,500. Our medical billing services page lists what's in the rate, with no software fees added on top.

Credentialing at $99 per Payer

Credentialing costs $99 per payer application, with no setup fee, and MedSole files applications within 48 hours. Speed matters here because a provider who isn't enrolled can't bill, while the timely filing clock keeps running on each visit that provider sees.

A new physician joining a practice that takes eight payers costs $792 to credential at that rate. Compare that with what you'd lose if one payer's enrollment stalls for three months and the claims from those visits age toward their deadlines.

The Math on One Missed Deadline

Take a practice that writes off 10 claims a month to CO-29 at $150 each. That's $1,500 a month, or $18,000 a year, lost to paperwork. The figures are an example, but they show why a deadline missed on a small claim adds up.

For a look at your own numbers first, a practice billing audit shows how many claims aged past their window last year and which payers caused them. If those numbers beat what you're paying now, it's worth a conversation.

Timely Filing Limit FAQs

What is timely filing in medical billing?

Timely filing is the rule that a claim must reach the payer within a set number of days after the date of service. Each payer sets its own window: 12 months for Original Medicare, 90 to 95 days for Texas and New York Medicaid, and 90 to 180 days for most commercial contracts.

Miss the window, and the payer denies the claim with CARC 29, shown as CO-29 on your remittance. Your practice writes off the balance, and in most cases you can't move it to the patient. The deadline counts the date the payer receives the claim.

Is there a time limit for medical billing?

Yes. Each payer sets a timely filing limit, and the claim must reach the payer before it expires. No single limit applies to all payers. Original Medicare allows 12 months, and federal rules cap Medicaid at 12 months, with 16 state programs setting less.

Commercial contracts allow 90 to 180 days in most cases, and TRICARE and CHAMPVA allow 1 year. A payer can deny a late claim even when the care was necessary and the coding was right, so the deadline deserves the same attention as the code set.

What is the timely filing limit for Medicare?

Original Medicare requires claims to reach the correct MAC within 1 calendar year of the date of service, under 42 CFR 424.44. Four exceptions can extend that window, including administrative error and retroactive Medicare entitlement, and each needs documentation.

A deadline that falls on a weekend or federal holiday moves to the next workday. Medicare Advantage plans follow your contract instead of the 12-month rule, and a late Original Medicare claim can't be appealed. Your only route is a reopening request built on one of the exceptions.

What insurances have a 90-day timely filing limit?

Several payers use 90 days for initial claims as of October 2026: Cigna for in-network providers, Anthem for Medicare Advantage professional claims, Wellpoint Medicare Advantage for participating providers, Fidelis Care, MetroPlusHealth, CareSource Indiana, and Optum Behavioral Health.

Medicaid in New York, New Mexico, and Massachusetts also starts with 90 days. Kaiser Permanente uses 90 days in its Colorado and Georgia regions. Check your contract before you rely on any of these, because a signed agreement can set a different window.

Does BCBS have a timely filing limit?

Yes, and each Blue company sets its own. Limits run from 90 days to 1 year depending on the plan and the product. Anthem uses 90 days for Medicare Advantage professional claims, while its New York commercial plans use 120 days.

Corrected claims have their own rules too. Highmark moved corrected claims to a 15-month window, counted from the original claim's finalization, on September 1, 2026. Pull the provider manual for the specific Blue plan on the patient's card instead of trusting a national grid.

What is timely filing for Medicare secondary claims?

Medicare secondary claims follow the same 12 months from the date of service as primary claims. Billing the primary payer first doesn't extend Medicare's deadline, and 42 CFR 424.44 contains no "later of" rule for secondary claims, whatever some guides say.

Bill the primary payer right after the visit, so its decision arrives with time left to file with Medicare. If the primary payer stalls for months, call it and escalate. The MAC won't add time to cover another payer's delay.

Can you bill a patient for timely filing denials?

In most cases, no. In-network contracts make a CO-29 denial a provider write-off, and Medicaid providers must accept Medicaid payment as payment in full. Medicare.gov tells beneficiaries that Medicare won't pay its share of a claim filed after 12 months.

Out-of-network claims depend on state balance billing law. A narrow exception can apply when the patient withheld insurance information and your contract allows billing in that case. Document the patient's role in the delay before you send any statement.

Why is timely filing important?

A missed deadline turns earned revenue into a write-off, and for Original Medicare a timely filing denial can't be appealed. Your provider did the work, the chart is complete, and the practice still collects nothing for the visit.

Timely filing limits also run shorter than many teams assume. Sixteen state Medicaid programs set less than 12 months, and plenty of commercial contracts allow 90 days. CMS asked in February 2026 whether to shorten Medicare's window for some high-risk items, so the topic keeps moving.

What does it cost to outsource medical billing and credentialing?

Most medical billing companies charge between 4% and 7% of collections. MedSole RCM is a full-service revenue cycle management company that charges 2.99% of monthly collections for medical billing and $99 per payer for provider enrollment and credentialing, with no setup fees and no long-term contracts.

On $50,000 in monthly collections, that's $1,495 a month for billing. Credentialing one provider with eight payers costs $792 through MedSole's payer enrollment at $99 service. MedSole's billing team tracks each payer's timely filing limit as part of that work.

How do I choose a billing company that won't miss filing deadlines?

Ask each company you're considering for these five things, in writing, before you sign a services agreement with any of them:

1. Transparent percentage pricing with no setup fee.
2. Denial management and AR follow-up included in the rate.
3. Deadline tracking by payer and by contract, not a generic grid.
4. A monthly report of CO-29 denials and timely filing write-offs.
5. In-house credentialing and no long-term contract.

MedSole RCM is a full-service revenue cycle management company that charges 2.99% of monthly collections for medical billing and $99 per payer for provider enrollment and credentialing, with no setup fees and no long-term contracts. Ask any company to show you its CO-29 rate across current clients, and compare the answers.

Sources and How This Guide Was Verified

We checked each figure in this guide against its primary document in October 2026: federal regulations, CMS manuals and transmittals, state Medicaid manuals and rules, state insurance law, and payer manuals. If no primary source states a timely filing limit, the table says "Verify" instead of guessing.

We review this page each quarter, and we update it sooner when CMS issues a change request or a major payer changes a filing rule. The "Last verified" date at the top shows the most recent full check.

Federal and national sources include 42 CFR 424.44, 447.45, 405.926, and 422.520; 32 CFR 199.7; 38 CFR 17.276; 38 U.S.C. 1703D; CMS Claims Processing Manual Chapter 1 (Rev. 13725); CMS CR 12909 and Transmittal 2140; Federal Register Doc. 2026-03968; and the X12 CARC list.

State and payer sources include the TMHP, Medi-Cal, and eMedNY manuals; 28 TAC 21.2806; 28 CCR 1300.71; New York Insurance Law 3224-a; the 51 state Medicaid sources named in the state table; and published manuals from Cigna, UnitedHealthcare, Aetna, HealthSpring, Humana, Wellcare, Wellpoint, Molina, Highmark, and EmblemHealth.