Timely Filing Limit for Claims in Medical Billing (2025 Update)

Submitting claims on time is a critical part of medical billing. Each insurance company sets a timely filing limit, which is the deadline for submitting claims after services are provided. If a claim is filed after this period, the insurance company may deny it, leading to lost reimbursement.

Timely filing limits vary widely between insurers, ranging from 30 days to two years. Keeping track of these deadlines is essential to prevent claim denials and maintain steady revenue. In 2025, payers continue to update their policies, making it even more important for providers to stay informed.

What Is a Timely Filing Limit?

A timely filing limit is the maximum time a healthcare provider has to submit a claim after providing a service. The countdown begins on the date of service, not when the claim is processed internally.

Late submissions often result in denials, and appeals for late claims are rarely successful. Some exceptions exist, such as payer system outages or proof of timely submission, but in most cases, missing the deadline means losing reimbursement. The best strategy is to submit claims as soon as possible and track deadlines closely.

Timely Filing Limits for Major Insurance Payers in 2025

Each insurance provider has its own rules for timely filing. Below are the deadlines for major insurers:

Medicare

• 12 months (1 year) from the date of service
• Applies to both Medicare Part A and Part B claims

Medicaid

• Varies by state
• Typically 90 days to 12 months

Blue Cross Blue Shield (BCBS)

• Depends on the state and plan
• Usually 90 days to 1 year

Aetna

• 120 days for most commercial plans
• 180 days to 1 year for some employer-sponsored and Medicare Advantage plans

Cigna

• 90 to 180 days for most commercial plans
• Some employer-sponsored plans allow up to 1 year

UnitedHealthcare (UHC)

• 90 to 180 days for commercial plans
• Up to 1 year for Medicare Advantage and employer-sponsored plans

Tricare

• 12 months (1 year) from the date of service
• Applies to Tricare Prime, Select, and Reserve Select

Worker’s Compensation

• Varies by state
• 30 days to 2 years, depending on state regulations

Since filing limits can change, providers should check payer contracts and policy updates regularly to avoid missing deadlines.

What Happens If a Claim Is Submitted Late?

If a claim is filed after the timely filing limit, the insurance company will likely deny it automatically. This means the provider will not receive payment unless an appeal is successful. Unfortunately, most appeals for late claims are denied unless the provider can show proof of timely filing or provide a valid reason for the delay.

Some payers allow appeals if providers can show that a claim was submitted on time but not processed due to a system issue or clerical error. In these cases, having electronic submission reports or fax confirmations can help overturn the denial. However, this is not guaranteed.

If a claim is denied for late filing, providers may have a few options:

• Submit an appeal with proof of timely filing (if available)
• Request a reconsideration if the delay was due to a payer’s system error
• Bill a secondary insurance if the patient has one, though this depends on whether the secondary payer requires a claim from the primary insurer first

In most cases, missing the deadline results in a permanent loss of reimbursement. This is why timely submission is critical for maintaining financial stability.

How to Avoid Timely Filing Denials

Preventing late claim denials requires strong billing processes. One of the most effective ways to ensure claims are submitted on time is by using electronic claim submission. Submitting claims through an electronic health record (EHR) system or medical billing software helps providers process claims faster and reduces human error.

Tracking payer rules is another key step. Each insurance company has different filing limits, so staying informed about contract terms and policy updates helps providers avoid missing deadlines. Many payers also offer online portals where providers can check claim submission status and deadlines.

Maintaining proof of submission is essential. Saving electronic receipts, fax confirmations, or submission reports provides documentation in case a claim is denied for late filing. This can be useful when appealing a denial or requesting reconsideration.

Having a dedicated claims management team also reduces the risk of missing deadlines. Whether billing is handled in-house or outsourced to a medical billing service, having experts track submission deadlines and payer rules ensures claims are sent on time.

Why Work with a Medical Billing Service?

Keeping up with timely filing limits can be challenging, especially for busy healthcare providers. A medical billing service ensures that claims are submitted promptly, reducing the risk of denials and revenue loss.

Billing specialists use automated systems to track filing deadlines, submit claims efficiently, and resubmit rejected claims. They also handle denial management, helping providers recover lost revenue whenever possible.

Certified Healthcare Billing specializes in fast claims submission and payer compliance, allowing providers to focus on patient care instead of paperwork. By outsourcing medical billing, healthcare practices can improve efficiency, reduce claim denials, and maximize revenue.

Frequently Asked Questions (FAQ)

What happens if a claim is denied due to late filing?

Most payers will not pay a late claim unless there is proof of timely submission or a valid reason for the delay. Appeals are rarely successful, so preventing late submissions is the best approach.

How can I check the timely filing limit for a specific insurance company?

The best way to find the correct filing limit is to check the payer’s provider manual, visit their website, or call provider support. Filing limits can change, so checking regularly is important.

Can a provider appeal a denial for late filing?

Appeals are possible but rarely approved unless the provider can show documented proof that the claim was submitted on time or that the delay was due to an insurance system error.

What’s the best way to prevent timely filing denials?

Submitting claims electronically, tracking deadlines, and working with a medical billing expert are the best ways to avoid timely filing denials.

Does Medicaid have the same timely filing limit in every state?

No. Medicaid filing limits vary by state, typically ranging from 90 days to 12 months from the date of service. Providers should check with their state’s Medicaid office for specific deadlines.