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Timely Filing Limits
by Major Payer
Missing a timely filing deadline means forfeiting the claim entirely — with no path to appeal. Use this guide to stay ahead of every payer's submission window.
Important: Timely filing limits are subject to change and may vary by plan, state, and contract terms. Always verify current deadlines directly with each payer or in your provider agreement. This guide reflects commonly published limits and should be used as a general reference only.
90 days or less — High risk, monitor closely
91–180 days — Moderate risk
181+ days — Lower risk, but never delay
Major Commercial Payers
| Payer | Filing Window | From | Risk Level | Notes |
|---|---|---|---|---|
| Aetna | 180 days | Date of service | MEDIUM | Some plans 90 days — verify per contract |
| Anthem / BCBS | 365 days | Date of service | LOWER | Varies by state and plan — confirm locally |
| Blue Cross Blue Shield | 365 days | Date of service | LOWER | BCBS plans are state-specific; verify your state |
| Cigna | 180 days | Date of service | MEDIUM | Some behavioral health carve-outs may differ |
| Humana | 365 days | Date of service | LOWER | Verify per plan type — HMO vs. PPO may differ |
| UnitedHealthcare | 365 days | Date of service | LOWER | Some UHC plans 90–180 days — check per plan |
| Magellan Health | 180 days | Date of service | MEDIUM | Behavioral health carve-out manager |
| Optum / UBH | 180 days | Date of service | MEDIUM | Behavioral health carve-out; verify per contract |
| Beacon Health Options | 180 days | Date of service | MEDIUM | BH carve-out; now part of Carelon Behavioral Health |
Medicare & Medicaid
| Payer | Filing Window | From | Risk Level | Notes |
|---|---|---|---|---|
| Medicare (Traditional) | 365 days | Date of service | LOWER | 1 calendar year from DOS — strictly enforced |
| Medicare Advantage | Varies | Date of service | MEDIUM | Each plan sets its own limit — often 90–365 days |
| Medicaid (Texas / TMHP) | 95 days | Date of service | HIGH | One of the shortest windows — monitor closely |
| Medicaid Managed Care (TX) | 95–180 days | Date of service | HIGH | Varies by MCO — verify with each managed care org |
| CHIP (Texas) | 95 days | Date of service | HIGH | Follows TMHP timely filing guidelines |
Secondary Claims & Special Situations
| Situation | Typical Window | From | Notes |
|---|---|---|---|
| Secondary claim (after primary EOB) | 90–180 days | Primary EOB date | Window starts from primary adjudication, not DOS |
| Corrected claim (resubmission) | Varies | Original remittance | Many payers allow 60–180 days from original EOB |
| Coordination of benefits (COB) | 90–365 days | Primary EOB date | Always attach primary EOB with secondary submission |
| Retroactive authorization | 30–60 days | Date of service | Very tight windows — act immediately if auth was missed |
| Late enrollment / credentialing gap | Varies | Enrollment effective date | Some payers allow retroactive billing; most do not |
Best Practice Tips for Timely Filing
Submit within 30 days of DOS
Don't rely on the full filing window. Submitting within 30 days gives you time to correct rejections before the deadline.
Track every payer's deadline separately
Maintain a payer-specific timely filing tracker. Never assume limits are the same across plans.
Flag aging claims at 45 & 60 days
Set internal alerts at 45 and 60 days for any unpaid claim. Don't wait for the 90-day mark to take action.
Save proof of timely filing
Always retain clearinghouse acceptance reports. These are your evidence if a payer denies a timely filed claim.
Know your secondary claim window
Secondary filing windows start from primary adjudication — not DOS. Post primary payments quickly to protect secondary filing rights.
Verify limits directly with payers
Limits published here are general. Your specific contract may have different terms — always confirm with the payer directly.
Struggling with timely filing denials?
SPF Revenue Cycle Solutions tracks filing deadlines and submits claims promptly — so you never lose revenue to a missed window.