Medicaid (state programs) Timely Filing Limit
Medicaid (state programs) allows 90 days – 1 year (state-specific) for initial claim submission, counted from date of service.
- Initial claims
- 90 days – 1 year (state-specific)
- Counted from
- Date of service
- Appeals
- Varies by state — commonly 30–90 days
- Category
- Government
Published default as of 2026 — individual participation agreements and plan documents override payer defaults. Always verify against your contract and the current provider manual.
What billers should know
Every state sets its own limit — commonly 90 days to 12 months for initial claims. Medicaid MCOs (managed care plans) often impose shorter contractual limits than the state FFS program. Check both the state manual and your MCO contract.
Missed the Medicaid (state programs) deadline?
- 1
Pull your proof of timely submission — clearinghouse acceptance reports (277CA), payer portal submission logs, or EDI acknowledgments. If the claim was submitted in time and lost or rejected downstream, most payers must reopen it.
- 2
The denial arrives as CO-29 — appeal with documentation, citing the original submission date and any payer-side errors (wrong member ID on file, retroactive eligibility, COB delays).
- 3
If the miss is genuinely yours, write it off correctly: timely filing denials are a contractual adjustment — billing the patient for them violates most network agreements.
- 4
Fix the root cause: charges should leave the door within 48–72 hours of the encounter, with a worklist for anything unbilled after 7 days.
OakClaim files every claim within 48 hours — no deadline math required.
Free audit shows how much late filing and unworked denials are costing you.