CRITICAL: Missing Timely Filing Deadlines Forfeits Claims
Most payers will not accept appeals or resubmissions after their timely filing window closes. Even if the claim should have been paid, missing the deadline means losing it permanently. There are no exceptions in most cases. Establish a system to track deadlines immediately upon denial.
Understanding Timely Filing
Timely filing is the payer's deadline for you to appeal a denial or resubmit a claim. The clock starts from different points depending on the payer:
Most Common Start Date: EOB Date
Most payers start the appeal window from the date of the EOB (Explanation of Benefits), not the date of denial within the EOB. This can be significantly different.
Some Payers: Date of Service
Some payers count from date of service or claim submission. Always check the specific payer's policy.
Key: Check the EOB
Most EOBs include appeal instructions and deadlines. This is your official notice. Calendar it immediately. Don't assume.
Medicare Timely Filing Deadlines
Important Note: These are standard Medicare rules. Your MAC (Medicare Administrative Contractor) or payer may have variations. Always confirm with your MAC.
Original Claim Submission
Time to submit after date of service
Part B claims must be submitted within 12 calendar months of the date of service. Submit sooner—don't wait until month 11.
Redetermination (First Appeal)
Time to appeal from EOB date
You have 120 calendar days from the EOB date to request a redetermination. This is a formal review by Medicare.
Reconsideration (Second Appeal)
Time from redetermination denial
If the redetermination is denied, you have 180 days from that denial to request a reconsideration.
Administrative Law Judge (ALJ) Appeal
If reconsideration is denied
After reconsideration denial, you can request an ALJ hearing within 60 days.
Commercial Payer Timely Filing Deadlines
Commercial payers are more variable. These are typical timelines, but vary by plan and state:
UnitedHealthcare
- Claim submission: 180 days from date of service
- First appeal: 180 days from EOB date
- Second appeal: 60 days from first appeal denial
Cigna
- Claim submission: 180 days from date of service
- First appeal: 365 days from EOB date
- Second appeal: 180 days from first appeal denial
Aetna
- Claim submission: 180 days from date of service
- First appeal: 180 days from EOB date
- Second appeal: 60 days from first appeal denial
Blue Cross/Blue Shield
- Claim submission: 180 days from date of service (varies by state)
- First appeal: 180 days from EOB date (varies by state plan)
- Second appeal: 60-180 days from first denial
Humana
- Claim submission: 180 days from date of service
- First appeal: 180 days from EOB date
- Second appeal: 60 days from first denial
State variations: Some states have different timely filing rules. Always verify with the specific payer in the state where the service was provided.
Medicaid Timely Filing Deadlines
Medicaid is administered by states, so deadlines vary significantly by state and managed care plan. Here are typical ranges:
⚠ Critical: Check Your State's Rules
Medicaid timely filing rules are state-specific. Contact your state Medicaid program and each managed care plan to confirm deadlines. This is not optional.
Typical Claim Submission Deadline
30-180 days from date of service (varies by state)
Typical Appeal Window
30-90 days from denial date (varies by state)
Some state Medicaid programs are more flexible with timely filing. Others strictly enforce deadlines. Know your state's policies.
Best Practices for Managing Timely Filing Deadlines
Build a payer deadline reference
Create a spreadsheet or document with each payer's timely filing rules. Update it annually. Share it with your billing team.
Calendar denial deadlines within 24 hours
When a denial arrives, immediately calculate the appeal deadline and calendar it. Don't rely on memory.
Build in a 2-week buffer
Don't appeal on the last day. Mail delays and payer processing delays can cause you to miss deadlines. Appeal at least 14 days before the deadline.
Use electronic submission when available
Online portals are faster and give you instant confirmation. Avoid mail and fax when you can.
Get written confirmation of submission
Don't just mail an appeal. Get a tracking number, confirmation email, or receipt. You'll need proof you submitted on time if there's a dispute.
Never Miss a Deadline Again
RediClaim tracks all your denials and alerts you to upcoming timely filing deadlines. You'll never miss a deadline window and lose a recoverable claim.
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