Timely Filing Limits by Payer: The Deadline Table (Medicare, Medicaid, Commercial)

Direct answer: A timely filing limit is the deadline by which a payer must receive your claim, and every payer sets its own. Original Medicare allows 12 months from the date of service. Medicaid allows no more than 12 months under federal rules, but individual states set much shorter limits, some as short as 90 days. Commercial plans typically allow 90 to 180 days. Medicare Advantage, Medicaid managed care, TRICARE, and CHAMPVA each run on their own rules. The hierarchy matters more than any single number in this article: your payer contract and your state law beat every figure on the page, so check the contract and the current provider manual for each payer before you rely on a deadline. A claim filed one day late is a claim the payer can refuse to pay, and for Original Medicare a late claim cannot be appealed.

The Hierarchy Comes First: Your Contract and State Law Beat the Table

No deadline table can replace the document that actually governs your claim. The order of authority runs like this. Federal regulation sets the ceiling for government programs: 42 CFR 424.44 caps Original Medicare at 12 months, and 42 CFR 447.45 caps Medicaid at 12 months. State law and the state Medicaid plan then set the real limit inside that ceiling, and states routinely set shorter ones. Your provider agreement with each commercial plan sets that plan's limit, and the plan's provider manual restates it. The numbers in this article come from those regulations and from payer-published provider manuals, and each one carries a warning to verify it against your current contract and manual, because payers change filing limits and because the version of the manual you are reading may not be the version that governs your agreement. If the table and your contract disagree, the contract wins. If the contract and state law disagree, state law wins. Keep a one-page payer deadline sheet for every payer you bill, with the limit, the contract section or manual page it came from, and the date you last checked it. Review it whenever a payer sends a contract amendment or a manual update, and whenever you add a new payer.

The Deadline Table

This is the payer-by-payer summary. Read the sections after the table for the rules behind each number, because the number alone does not tell you when the clock starts, what counts as received, or what happens if you miss it.

Original Medicare: 12 Months, and the Receipt Date Controls

Original Medicare, Part A and Part B, gives providers 12 months, or 1 calendar year, from the date of service to file a claim, under 42 CFR 424.44. The Affordable Care Act set this as the maximum period for all Medicare fee-for-service claims for services furnished on or after 1 January 2010. Two details decide whether a claim is on time. First, the receipt date controls, not the postmark. Medicare measures timeliness by when the Medicare Administrative Contractor receives the claim, so a claim mailed on the last day of the window but received after it is late. Electronic filing removes this risk, because the clearinghouse and the contractor record the receipt date. Second, only four narrow exceptions exist that allow an extension, for example an error by the Medicare contractor or retroactive Medicare entitlement for the beneficiary. The exceptions are narrow by design and each one has its own documentation requirement, so do not plan around them. A claim denied for untimely filing under Original Medicare cannot be appealed. That is the hardest consequence in this whole article: there is no appeal path for a late Original Medicare claim, only the narrow exceptions. The practical rule follows from that. Treat the Medicare deadline as if it were 11 months, not 12, and file every Medicare claim within days of the date of service. A claim that sits for months is a claim exposed to a rejection, a clearinghouse error, or a payer request that eats the remaining window.

Medicare Advantage: The Contract Sets the Clock

Medicare Advantage does not work like Original Medicare here. For a contracted provider, the timely filing limit is whatever the plan's provider agreement says, and there is no single CMS number that covers every plan. One plan may allow 180 days, another 90, and a third may mirror the 12-month Medicare rule. You find the number in the contract and in the plan's provider manual, and you verify it plan by plan. For a non-contracted provider, CMS sets a 12-month floor under 42 CFR 422.520, which means a Medicare Advantage plan may not impose a shorter filing limit on a non-contracted provider than 12 months. Do not confuse the floor with the contracted rule: the floor protects non-contracted providers, while contracted providers live by their agreement. A practice that bills several Medicare Advantage plans needs a separate deadline entry for each one, because assuming the Original Medicare 12-month rule applies to a contracted Advantage plan is exactly the mistake that produces a timely filing denial.

Medicaid Fee-for-Service: A 12-Month Ceiling, Shorter State Limits

Medicaid fee-for-service has a federal ceiling of 12 months under 42 CFR 447.45, which means a state Medicaid program may not allow more than 12 months, but it may require much less. The state limits vary widely, and the examples below show the range. Texas allows 95 days from the date of service. New York allows 90 days. Medi-Cal, California's Medicaid program, allows 6 months. Florida allows 12 months, the full federal ceiling. These are state-set figures, so they change when the state changes its plan, and they apply to fee-for-service Medicaid claims in that state. A practice billing Medicaid in more than one state needs a deadline entry for each state, because a filing habit that is safe in Florida, at 12 months, is far too slow in New York, at 90 days. Verify the current limit in the state Medicaid provider manual before you rely on any of these figures, and check whether your state counts the clock from the date of service or from another event, because that detail varies too.

Medicaid Managed Care: Check the Plan Manual

Medicaid managed care does not follow the fee-for-service number for the state. The limit is set by the state contract with the managed care organization and by the plan's own provider manual, so two plans in the same state can have different deadlines. Published examples show the range: TennCare managed care organizations allow 120 days, and Fidelis Care allows 90 days. Treat these as examples of what plans set, not as a rule for your plan. The only number that governs your claim is the one in the contract and manual for the specific managed care plan you are billing. Because managed care plans update their manuals regularly, diary a manual check for each Medicaid managed care plan at least once a year, and again whenever the plan sends a provider notice.

Commercial Payers: 90 to 180 Days, Set by Contract

Commercial plans set their own timely filing limits in the provider agreement, and the usual range is 90 to 180 days. The figures below come from payer-published provider manuals, and each one should be verified against your current provider manual before you rely on it. Cigna allows 90 days for in-network claims and 180 days for out-of-network claims. UnitedHealthcare allows at least 90 days for participating providers and up to 180 days for non-participating providers, so the exact number depends on your participation status with that plan. Humana allows 90 days. Aetna publishes no general day count in its public provider manual, the June 2026 edition, so do not present an Aetna day count as settled: sources conflict on Aetna, and the only reliable number is the one in your own provider agreement with Aetna. The commercial range is the reason this article keeps repeating the same warning. A practice that bills five commercial plans may be working with five different deadlines, and the shortest one, not the average, decides how fast claims must go out. Build your claim submission workflow around the shortest deadline in your payer mix, and treat a claim older than 30 days as a claim that needs a reason to still be sitting there.

TRICARE and CHAMPVA: One Year

TRICARE allows 1 year to file a claim for care received in the United States and 3 years for care received overseas, under 32 CFR 199.7(d). The longer overseas window reflects the practical difficulty of filing from outside the country, but it does not remove the deadline: a claim filed after the window closes can be denied. CHAMPVA, the health program for dependents of certain veterans, allows 1 year to file, under 38 CFR 17.276. Both programs are smaller parts of most practices' payer mix, which is why their deadlines get missed: a claim that would be routine under a commercial plan can sit quietly past a one-year limit while the team focuses on the payers that deny faster. Put TRICARE and CHAMPVA on the same deadline sheet as every other payer, with the same aging checks.

When the Clock Starts: Date of Service and the Secondary-Payer Rule

For a primary claim, the clock almost always starts on the date of service. For a secondary claim, the clock starts from the primary payer's explanation of benefits date, because the secondary payer cannot be billed until the primary payer has adjudicated the claim. That distinction matters most with Medicare crossover claims, where Medicare forwards the claim to the secondary payer automatically in many cases, and with any claim where the primary payer takes weeks to adjudicate. Do not wait for the primary explanation of benefits to arrive on paper before starting the secondary filing: track the primary claim, pull the explanation of benefits the day it posts, and file the secondary claim the same week. A secondary filing that waits for a paper remittance can lose the entire secondary window. Also confirm how your payer defines receipt, because that is the other end of the clock. Electronic claims carry a receipt date from the payer or clearinghouse. Paper claims are measured by the date the payer receives them, not the date you mailed them, so a paper claim filed near a deadline carries delivery risk that an electronic claim does not. The worked example below shows why the payer type, not the service, decides the outcome.

Worked Example, an Illustrative Filing

This example is illustrative, with generic facts and no real client, patient, or practice. A service is furnished on 1 March. The practice files the claim on day 95 after the date of service. For a commercial payer with a 90-day timely filing limit, the claim is 5 days late, and the payer can deny it as untimely filed. The practice can appeal the denial or ask for an exception, but the payer is not obliged to pay a claim filed outside its contract limit. The same service, filed on the same day, under Original Medicare's 12-month rule, is comfortably on time, with months of window remaining. Nothing about the service changed. Nothing about the coding changed. The payer type decided the outcome. Now change one fact: the practice files the same commercial claim on day 85 instead of day 95. The claim is on time, and the denial never happens. The difference between the two outcomes is ten days of filing speed, which is why the practical rule in this article is to file every claim within days of the date of service and to run an aging report every week. A claim that is 30 days old is not a problem yet. A claim that is 80 days old with a 90-day payer is an emergency.

What Happens When a Claim Is Late

A late claim is usually denied with a timely filing denial, and the denial code tells you which rule the payer applied. For Original Medicare, the consequence is final in a way it is not for other payers: a late Original Medicare claim cannot be appealed, so the only routes are the narrow exceptions. For commercial and Medicaid payers, an appeal is usually possible, but the appeal is an uphill one, because the payer's position is that the contract gave you the deadline and the claim arrived after it. The strongest appeal ground is proof that the claim was actually received on time, for example a clearinghouse acceptance report or an electronic receipt showing a receipt date inside the window. That is why the confirmation record matters: save the clearinghouse acceptance and the payer receipt for every claim, and keep them where the appeals team can find them without searching. If the claim was genuinely late, the realistic options are a good-cause exception request, where the payer's manual allows one, or writing the balance off, because billing the patient for a claim denied as untimely filed is restricted or prohibited under many contracts and under Medicare rules. Check your contract before any patient billing follows a timely filing denial.

The Weekly Aging Workflow

A deadline table only helps if someone watches the clock. Run a weekly aging report that lists every unbilled charge and every unfiled claim by age and by payer, sorted so the shortest-deadline payers sit at the top. Flag any claim older than 7 days as overdue for filing, any claim older than 30 days as needing a named owner and a reason, and any claim within 30 days of its payer's deadline as an escalation. The owner of the report chases the blocker each week: a missing charge, a coding question, an eligibility check, or a payer portal problem. Most late claims are not late because the team was slow; they are late because a single claim sat in a queue nobody owned while the deadline passed. The weekly report, with a named owner and a short list of blockers, is the control that prevents that. Pair it with the payer deadline sheet from the start of this article, and a new hire can see at a glance which payer needs a claim today and which one can wait until tomorrow.

Checklist

• Build a payer deadline sheet for every payer you bill, with the limit, the contract section or manual page it came from, and the date you last checked it, and review it when a contract amendment or manual update arrives.
• File every claim within days of the date of service, and treat the Medicare deadline as 11 months, not 12.
• Run a weekly aging report sorted by payer deadline, with the shortest deadlines at the top, and assign a named owner to every claim older than 30 days.
• Save the clearinghouse acceptance and the payer receipt for every claim, so a timely filing dispute has proof of the receipt date.
• For secondary claims, file from the primary payer's explanation of benefits date, and pull the remittance the day it posts rather than waiting for paper.
• Verify every commercial figure in this article against your current provider manual, and check your Aetna provider agreement directly, because Aetna publishes no general day count in its public provider manual.
• Never bill a patient for a claim denied as untimely filed without checking the contract first.
• Diary a manual check for each Medicaid managed care plan at least once a year.

A note on codes and coverage: This article is educational information about billing deadlines, not legal or compliance advice. Timely filing limits, payer contracts, and state Medicaid rules vary by payer and state and change over time, so always verify the current limit against your provider agreement, the payer's current provider manual, and the governing regulation before acting. The figures in this article come from the regulations and payer manuals cited, and commercial figures in particular should be checked against your current provider manual.

Related reading: Timely Filing Limit in Medical Billing · How to Appeal a CO 29 Timely Filing Denial · Claim Denial Management Workflow · Claim Denial Codes: Complete Guide · Medicare Crossover Claim: Secondary Payer Not Paying