Timely filing is the window in which a payer will accept a claim after the date of service. Claims that arrive late are usually denied as expired, and appeals rarely succeed. Deadlines differ by payer and contract, so use this as a guide and check your own agreements.
Medicare
For Original Medicare fee-for-service, claims generally have to be filed within one calendar year (12 months) of the date of service.
Commercial insurance
Commercial payers set their own limits in the provider contract, and they commonly range from about 90 days to a year. Many are shorter than Medicare's, so billing quickly matters.
Texas managed care plans
In Texas, the Texas Department of Insurance has stated that the 95-day claim filing deadline in the Insurance Code applies to physicians and providers who submit claims to managed care carriers, regardless of whether they are contracted. The Texas Prompt Pay Act also sets time limits for insurers, generally 30 days to pay, deny or audit a clean electronic claim and 45 days for a non-electronic one, for the plans the Act covers. Self-funded employer plans are generally outside the state's rules.
Medicaid and other programs
Medicaid and other government programs have their own filing deadlines. For Texas Medicaid, check the current provider manual for the limit that applies to your service.
Corrected claims and appeals
Corrected claims and appeals have separate deadlines, which are often shorter than the original filing window. A Medicare redetermination request, for example, generally has to be filed within 120 days of the initial determination.
How to avoid missing deadlines
- Submit claims within days of the visit, not weeks.
- Track filing limits for each payer in a simple reference sheet.
- Keep proof of timely filing, such as clearinghouse acceptance reports.
- Work rejected and unpaid claims promptly through A/R follow-up.
- Review the oldest claims in your A/R every week.
Our claims processing team submits claims quickly and tracks deadlines for Texas practices and others. See our Texas locations.
Frequently Asked Questions
What happens if I miss the timely filing deadline?
The claim is usually denied and cannot be billed to the patient if you are in network. Proof of earlier submission is the main way to appeal.
Do these deadlines change?
Yes. Laws, contracts and payer policies change, so confirm the current rules with each payer.
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