Timely filing limits are the deadlines imposed by commercial insurance companies or government payers for submitting healthcare claims for reimbursement. Timely filing limits are put in place to ensure efficient claim processing, maintain accurate financial records, and control healthcare fraud.
Understanding timely filing limits is crucial for healthcare providers, medical billing companies, and patients, as it affects the overall revenue cycle and reimbursement processes.
Contents
Importance of Timely Filing Limit
Timely filing limits are essential for the following reasons:
1. Ensuring prompt payment for healthcare services.
2. Maintaining accurate financial records.
3. Reducing the risk of denied claims and lost revenue.
4. Streamlining claims processing and reducing administrative costs.
5. Encouraging a consistent workflow in the revenue cycle.
6. Reducing the risk of fraud and abuse in the healthcare system.
Timely Filing Limits of Common Insurance Companies
Timely filing limits vary depending on the payer as well as the type of claim submission. Timely filing limit for fresh claim, denied claim, claim reconsideration, and appeal varies depending on insurance company.
Here is the list of all type of timely filing limits of healthcare insurance companies operating in USA:
AARP Supplemental Timely Filing Limit
The timely filing limit for AARP Medicare Supplemental Insurance plan, insured by United Healthcare, is typically 15 months from the date of service
Aetna Timely Filing Limit
Aetna’s timely filing limit is generally 120 days from the date of service for in-network providers and 180 days for out-of-network providers. However, these limits may vary depending on the specific plan or state regulations. Below I have mentioned timely filing limits of different insurance plans of Aetna.
Aetna Appeals Filing Limit
Aetna’s appeals filing limit is typically 60 days from the date of the initial claim denial or previous decision for in-network providers. However, the limit may vary depending on the specific plan, contract, or state regulations.
Aetna Better Health Timely Filing Limit
The timely filing limit for Aetna Better Health Plan is 180 Days from the Date of Service.
Aetna Denied Claims Filing Limit
For Aetna denied claims, the filing limit for resubmitting corrected claim is 180 days from the date of the initial claim denial. It is crucial to consult the provider customer service to confirm the exact timeframe for resubmitting denied claims for a specific Aetna plan.
AMA Timely Filing Limit: 2 Years from Date of Service
Ambetter for Non Participating providers TFL: 365 Days from date of service
Ambetter for Participating providers Filing Limit: 120 days from date of service
Ambetter for Reconsideration or Appeals Timely Filing Limit: 365 Days
American Life & Health TFL: 1 Year from Date of Service
Amerigroup for Non Participating Providers Filing Limit: 365 Days
Amerigroup for Participating Providers TFL: 180 Days
Anthem Health Coastwise Claims Timely Filing Limit: 3 Years from Date of Service
Bankers Life Filing Limit: 15 months from date of service
Benefit Concepts Timely Filing Limit: 12 months from date of service
Benefit Trust Fund TFL: 1 year from date of Medicare EOB
Blue Cross PPO Filing Limit: 1 year from date of service
Blue Shield TFL: 1 year from date of service
Bridgestone/Firestone Timely Filing Limit: 12/31 of the following year of service
Champus Filing Limit: 1 year from date of service
Cigna for Non Participating Provider TFL: 180 days from the date of service
Cigna for Participating Providers Timely Filing Limit: 90 days from the date of service
Coventry Filing Limit: 180 days from the date of service
Fire Fighters /Local 1014 TFL: 15 months from the date of service
FMH Timely Filing Limit: 6 months from the date of service
FRA Filing Limit: 15 months from the date of service
GHI for In Network Claims TFL: 1 year from the date of service
GHI for Out of Network Claims Timely Filing Limit: 18 months from the date of service
GHI Secondary Filing Limit: 365 Days from the primary EOB date
Great West/AH&L/ Timely Filing Limit: 90 dates from date of service
Healthfirst TFL: 1 year from the date of service
Healthnet Access Filing Limit: 6 months from date of service
HealthNet PPO Timely Filing Limit: 120 days from date of service
HIP Primary Insurance TFL: 120 days from date of service
HIP Secondary Payer Filing Limit: 120 days from date of service
Humana Commercial Claims Timely Filing Limit: 90 Days from the date of service
Humana Medicare Claims TFL: 1 year from the date of service
ILWU Filing Limit: 3 years from the date of service
Kaiser Permanente Timely Filing Limit: 90 days from the date of service
Keystone First Initial Claims TFL: 180 days from the date of service
Keystone First Resubmissions & Corrected Claims Filing Limit: 365 days from the date of service
Local 831 Health Timely Filing Limit: 1 year from the date of service
Medicare Appeals TFL: 120 days from original determination
Medicare Initial Claims Filing Limit: 12 months
Mega Life & Health Timely Filing Limit: 15 months from the date of service
Molina Healthcare Initial claims TFL: 1 Calender year from the date of service
Molina Healthcare Secondary Filing Limit: 180 Calender days from Primary EOB processing date
Motion Picture Ind. Timely Filing Limit: 15 months from the date of service
Mutual of Omaha TFL: 1 year from the date of service
Nationwide Health Filing Limit: 15 months from the date of service
One Healthplan Timely Filing Limit: 15 months from the date of service
Operating Engineers TFL: 1 year from date of service
Pacificare (PPO) Filing Limit: 90 days from the date of service
Principal Financial TFL: 3 years from the date of service
Prospect Medical Group (PMG) Timely Filing Limit: 90 days from the date of service
SMA Filing Limit: 1 year from the date of service
So. Ca Drug Benefit TFL: 1 year from the date of service
Tricare East Timely Filing Limit: 1 year from the date of service
Tricare West TFL: 1 year from the date of service
Troa/Mediplus Filing Limit: 2 years from the date of service
UHC Community Timely Filing Limit: 120 days from date of service
United Healthcare Appeals TFL: 12 months from original claim determination
United Healthcare Non Participating Providers Filing Limit: 180 days from the date of service
United Healthcare Participating Providers TFL: 90 days from the date of service
United Healthcare Secondary Filing Limit: 90 days from Primary EOB processing date
Wellcare Medicare Timely Filing Limit: 180 days from the date of service
How to Determine Your Timely Filing Limit?
To determine the timely filing limit for a specific payer, follow these steps:
1. Review the payer’s provider manual or contract, which should outline the filing requirements and deadlines.
2. Contact the payer’s provider relations department if the information is not readily available in the manual or contract.
3. Keep a record of filing deadlines for each payer you work with to ensure compliance.
You can also use our list of timely filing limits to find latest timely filing limits of all insurance companies.
Tips for Ensuring Claims Timely Filing
Here are some best practices to help ensure timely filing of claims to insurance companies:
1. Implement efficient billing and coding processes to minimize errors and reduce claim rejections.
2. Utilize electronic claims submission to expedite processing and receipt of payment.
3. Track claims and monitor their status to address any issues promptly.
4. Train staff on timely filing requirements and the importance of adhering to deadlines.
5. Maintain a calendar with timely filing deadlines for each payer to ensure timely submissions.
What are the consequences of missing timely filing deadlines?
Failure to meet timely filing limits can result in:
1. Denied claims, leading to lost revenue.
2. Increased administrative costs due to re-processing and appealing denied claims.
3. Strained relationships with payers, potentially impacting contract negotiations.
4. A negative impact on cash flow and financial stability.
What is the denial code for timely filing?
Denial codes, also known as Claim Adjustment Reason Codes (CARCs), are used by insurance payers to communicate the reason a claim has been denied or adjusted. The denial code for timely filing may vary depending on the payer, but standard timely filing codes issued by CMS include the following:
CO 29 Denial Code
The time limit for filing has expired.
PR 29 Denial Code
The time limit for filing has expired.
In some cases, the payer may also use a unique, payer-specific denial code to indicate that the claim was denied due to not meeting the timely filing limit. It’s important to review the EOB or Electronic Remittance Advice (ERA) received from the payer to understand the specific denial code and reason for the denial. This information will be crucial in resolving the issue and potentially appealing the denial if appropriate.
Appealing Denied Claims Due to Late Submission
If a claim is denied due to late submission, follow these steps to appeal:
1. Review the denial reason and gather any supporting documentation that proves the claim was submitted within the timely filing limit or a valid reason for late submission.
2. Contact the payer’s provider customer service department to discuss the denial and gather information on the appeals process.
3. Submit a written appeal, including supporting documentation, within the payer’s specified timeframe for appeals.
4. Follow up regularly with the payer to track the status of the appeal.
Final Remarks about Timely Filing Limit
Understanding and adhering to timely filing limits is crucial for healthcare providers and billing companies. Implementing efficient billing processes and systems can help ensure timely and accurate claims submissions, which will result in faster reimbursement and improved cash flow.
By staying up to date on payer-specific deadlines, training staff on timely filing requirements, and monitoring claim statuses, providers can minimize denied claims due to timely filing and maintain strong relationships with payers.
My name is Kathryn Belvin, a seasoned medical billing expert with over 20 years of experience in medical billing. I have a deep understanding of complex coding and billing reimbursement processes in the RCM field and a proven track record of success in optimizing revenue cycle for providers. My years of experience helped me build good PR with insurance representatives and I am here to assist fellow medical billers to reach out to insurance companies for claims processing.
Feel free to contact me at any time if you need any additional information which isn’t available on the website.