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Timely Filing Limits
How long you have to submit claims and appeals, payer by payer. These are published defaults — your contract always governs, so verify against your participation agreement.
31 payers shown — published defaults; your contract governs
| Payer | Initial claims | Appeals |
|---|---|---|
| Medicare (Original)Government | 12 months | 120 days from initial determination (redetermination) |
| Medicare Advantage (all carriers)Government | 90 days – 12 months (plan-specific) | 60 days (CMS-mandated for reconsiderations) |
| Medicaid (state programs)Government | 90 days – 1 year (state-specific) | Varies by state — commonly 30–90 days |
| TRICAREGovernment | 1 year | 90 days from the EOB/denial |
| VA Community Care NetworkGovernment | 180 days | 90 days (reconsideration through the CCN administrator) |
| AetnaNational Commercial | 90–120 days (contract-dependent) | 180 days from the denial (commercial) |
| UnitedHealthcareNational Commercial | 90 days (commercial) | 65 days from the EOB/PRA |
| CignaNational Commercial | 90 days (in-network); 180 days (out-of-network typical) | 180 days from the denial |
| HumanaNational Commercial | 90–180 days by plan | 180 days (commercial); 60 days (Medicare Advantage) |
| Kaiser PermanenteNational Commercial | 90–180 days by region | Varies by region — commonly 180 days |
| Ambetter (Centene)National Commercial | 120–180 days (state-specific) | Commonly 60–90 days — check your state's provider manual |
| Molina HealthcareNational Commercial | 90–180 days (state/program-specific) | Commonly 60–90 days by state program |
| Oscar HealthNational Commercial | 90 days (typical) | 180 days (typical) |
| BCBS of Texas (HCSC)BCBS Plans | 95 days | 180 days (claim review request) |
| BCBS of Illinois (HCSC)BCBS Plans | 95 days (contracted) — some contracts 180 days | 180 days (claim review request) |
| BCBS of Oklahoma (HCSC)BCBS Plans | 95–180 days (contract-dependent) | 180 days (claim review request) |
| BCBS of New Mexico (HCSC)BCBS Plans | 95–180 days (contract-dependent) | 180 days (claim review request) |
| Florida Blue (BCBS of Florida)BCBS Plans | 6 months (commonly cited); some contracts 12 months | 180 days (provider dispute) |
| Anthem BCBS (14 states)BCBS Plans | 90 days (many states) — up to 180 by contract | 180 days (claim payment dispute, most states) |
| Horizon BCBS of New JerseyBCBS Plans | 180 days (commonly cited) | 90 days–180 days by product; NJ state appeal rights may add more |
| Highmark BCBS (PA/WV/DE/NY)BCBS Plans | 90–365 days (product- and state-dependent) | 180 days (typical) |
| CareFirst BCBS (MD/DC/VA)BCBS Plans | 180 days (commonly cited); 365 days some products | 180 days (typical) |
| BCBS of MichiganBCBS Plans | 1 year (commonly cited for many contracts) | 180 days (typical) |
| BCBS of North CarolinaBCBS Plans | 180 days (commonly cited) | 90–180 days by product |
| BCBS of MassachusettsBCBS Plans | 90 days (commonly cited); some contracts longer | Varies by product — commonly 180 days |
| Premera Blue Cross (WA/AK)BCBS Plans | 365 days (commonly cited) | 180 days (typical) |
| BlueCard (out-of-area BCBS claims)BCBS Plans | Your LOCAL plan's limit applies | Local plan's dispute process |
| UMR (UnitedHealthcare TPA)TPA / Other | Plan document governs — commonly 90–180 days | Per plan document — commonly 180 days |
| Meritain Health (Aetna TPA)TPA / Other | Plan document governs — commonly 90–180 days | Per plan document — commonly 180 days |
| GEHA (federal employees)TPA / Other | December 31 of the year AFTER the year of service | OPM disputed-claims process (FEHB rules) |
| Workers' Compensation (state systems)TPA / Other | State-specific — often 1 year+, tied to claim acceptance | State WC board process |
Missed a deadline already?
A timely filing denial arrives as denial code CO-29. It's appealable more often than billers think: proof of timely submission (clearinghouse acceptance reports, certified mail receipts), payer processing errors, retroactive eligibility, and incorrect member ID situations can all reopen the clock. And remember — timely filing denials are a contractual write-off. Billing the patient for them is prohibited under most network agreements.
Deadlines shouldn't be a memory game.
We track every payer's clock automatically and file claims within 48 hours of the encounter. Find out what late filing is costing you.