Ever had that moment where you find an old claim in your EHR and think, “Wait… can we still bill this?”
You’re not alone, and you’re definitely not the first person to ask.
At Cadence Collaborative, we’ve seen how confusing the timely filing rules can be. Some providers think it’s 90 days across the board. Others assume it depends on the state. The truth? It depends on the payer.
And if you’re working with multiple insurance companies — Medicare, Medicaid, commercial plans, maybe even a few workers’ comp claims — those rules can stack up fast.
This guide is here to simplify all of that. We’ll walk you through how timely filing actually works, what deadlines really apply, how to avoid getting stuck with denied claims, and how to build a workflow that keeps your revenue right on track.
What Are Medical Billing Time Limits by State?
You’ve probably searched for “medical billing time limits by state,” thinking you’d find a nice, clean chart with each state and its exact deadlines. But here’s the truth: for most claims, state law isn’t what determines your filing deadline — your insurance payer is.
That’s right. Commercial insurers like Aetna, Cigna, and UnitedHealthcare don’t care whether you’re in Oregon or Florida.
What matters is their own internal policy, which is usually spelled out in the provider manual or your contract.
The one major exception is Medicaid. Because Medicaid is run at the state level, each program has its own rules — some states give you 90 days to submit, others offer a full year.
The same goes for workers’ comp and certain state-regulated exchange plans.
So while the phrase “by state” is popular in search engines, what you really need is a payer-specific approach backed by a clear internal workflow.
We’ll break down both in the next sections.
What Are Medical Billing Timely Filing Limits?
Timely filing limits refer to the maximum amount of time a provider has to submit a medical claim after services are rendered.
If a claim is submitted after this window, it’s likely to be denied, regardless of whether the care was appropriate or the documentation is perfect.
These limits apply to:
- Initial claim submission
- Corrected claims (in some cases)
- Retroactive eligibility billing
Important: Each payer sets their own filing window — there is no national standard.
Do Timely Filing Limits Vary by State?
Not really — but let’s go a little deeper.
As we’ve clarified above, most timely filing deadlines come from the payer, not the state. But this is still worth unpacking, because the confusion is widespread — and it’s not totally unfounded.
Why the Confusion Exists
Many billing teams assume state lines determine filing windows because Medicaid, workers’ comp, and some state-run exchange plans do vary by state.
But the vast majority of claims — especially from commercial plans like Aetna, UnitedHealthcare, and Cigna — are governed by payer-specific policies that apply nationally.
So even if you’re in a state that allows a full year for Medicaid submissions, your Aetna commercial claim might be denied at 91 days.
Common Filing Limits by Major Payers
Use this chart as a starting point — but always check your payer contract or provider manual for updates.
| Payer | Typical Filing Deadline |
| Medicare | 12 months from the date of service |
| Medicaid (varies) | 90–365 days (state dependent) |
| UnitedHealthcare | 90 days (some allow 180) |
| Aetna | 90–180 days |
| Cigna | 90–180 days |
| Blue Cross Blue Shield | 180–365 days (varies by region) |
| TRICARE | 1 year |
| Kaiser Permanente | 90 days |
| Workers’ Comp | 30–90 days (varies by carrier/state) |
When Does the Clock Start?
For most payers, the filing window begins on the date of service (DOS) — not the date of documentation, billing entry, or patient check-in.
Key Starting Points:
- Outpatient visit: date of appointment
- Inpatient: date of discharge
- Emergency care: date care began
- DME or supplies: date of delivery
For newborns or retroactive eligibility cases, some payers allow the clock to start after eligibility is confirmed, but that often requires manual appeal and supporting documentation.
What Happens If You Miss the Deadline?
Can You Appeal a Late Submission?
In some cases, yes. You may be able to submit a timely filing appeal if:
- The patient’s coverage was retroactive
- There was a payer processing issue
- The provider was newly credentialed
- The claim was submitted but not accepted due to a clearinghouse error
Be prepared to provide:
- Original claim submission reports or clearinghouse logs
- Proof of eligibility verification
- Written explanation of the delay
- Payer-specific appeal forms or cover letters
Tip from Cadence: Always submit the late claim anyway. Even if it’s denied, it keeps the door open for an appeal.
How to Track and Manage Filing Deadlines
Build a Proactive Workflow
At Cadence Collaborative, we recommend a filing management strategy that includes:
1. Create a Payer Deadline Tracker
Build a live document or dashboard with:
- Payer name
- Filing limit (in days)
- Claim submission format (paper, electronic, portal)
- Appeal requirements
2. Audit Aging Claims Weekly
Review open claims by date of service, not date entered. Look for claims over 30, 60, and 90 days.
3. Set EHR Alerts or Task Reminders
Some EHRs/PMs allow for automatic warnings when a claim is approaching the timely filing limit. Use them.
4. Prioritize High-Risk Payers
Flag payers with shorter limits (like 90-day deadlines) for weekly priority in your billing cycle.
5. Train Your Clinical Team
Timely billing starts with timely documentation. Encourage providers to close notes quickly and sign off the same day.
FAQs About Timely Filing in Medical Billing
How long do I have to bill Medicare?
You have 12 months from the date of service to submit a claim to Medicare. If the claim is not received within that window, it will be denied with no payment.
Is there a standard timeline all payers follow?
No. Every payer sets its own rules. There is no industry-wide standard, which is why tracking deadlines payer-by-payer is essential.
What if the delay was the payer’s fault?
If you can document that the claim was submitted on time but rejected in error, most payers will allow resubmission or appeal. Keep all clearinghouse logs, confirmation reports, and correspondence.
Can I bill for services retroactively if a patient gains eligibility later?
Possibly. Many payers allow billing for retroactive Medicaid or ACA coverage, but the window may be as short as 30 days. Submit immediately upon confirmation of eligibility.
Do corrected claims have the same deadline?
Not always. Some payers allow additional time for corrected claims after the initial claim was submitted, while others apply the same deadline across the board. Check your payer policy.
Does the place of service affect filing limits?
No — the place of service (telehealth, home, outpatient, etc.) doesn’t typically affect timely filing windows. What matters most is payer policy and contract terms.
Final Thoughts
Timely filing isn’t just about compliance — it’s about protecting your revenue.
Missing a deadline by even one day can result in a complete denial, no matter how clinically sound or well-documented the service was.
The good news? With the right tracking, team workflows, and payer-specific awareness, you can stay well ahead of the clock.
At Cadence Collaborative, we help healthcare providers and billing teams build smart systems to prevent costly delays, clean up aging AR, and keep every claim moving forward.
If your practice needs help navigating filing limits — or just wants a second look at your claims workflow — we’re ready when you are.
Let’s get your billing back on schedule. Contact us today for a timely filing audit.
