timely filing limit in medical billing

Timely Filing Limit in Medical Billing (2024)

The Timely Filing Limit is the time duration from service rendered to patients and submitting claims to the insurance companies. For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. It is 30 days to 1 year and more and depends on insurance companies.

The patient or medical billing agency’s responsibility is to submit his/her claim to insurance within the timely filing limit otherwise claims will be denied due to timely filing exceeded(CO-29).

Timely Filing Limit of Insurance Companies

The list is in alphabetical order

DOS- Date of Service

Insurance NameTimely Filing Limit
AARP15 Months from Date of Service (DOS)
ABC IPA90 days from the date of service
Accountable Health90 days from the date of service
ADOC IPA90 days from DOS
Advantage Care6 Month
Advantage Freedom2 Years from DOS
Aetna (HMO)120 days from the date of service
Aetna timely filing120 Days from DOS
Alliiance IPA1 year from DOS
AMA2 Years from DOS
Ameri health ADM Local 3601 Year from DOS
American Life and Health12 Month
American Progressive1 Year
Amerigroup90 Days for Participating Providers/12 Months for Non-par Providers
Amerihealth ADM TPA1 Year
AmeriHealth NJ & DE60 Days
Angeles IPA90 days from the date of service
Anthem Health(Coast wise Claims)3 Years from DOS
Applecare IPA90 days from DOS
Arbazo180 Days
Asian Community IPA90 days from DOS for contracted and 180 days for non-contracted
B/C HMO90 days from DOS
B/C Medi-cal90 days from DOS
Bankers Life15 Month form DOS
BCBS COVERKIDS120 Days from DOS
BCBS Florida timely filing12 Months from DOS
BCBS timely filing for Commercial/Federal180 Days from Initial Claims or if secondary 60 Days from Primary EOB
BeechStreet90 Days from DOS
Benefit Concepts12 Months from DOS
Benefit Trust Fund1 year from Medicare EOB
Blue Advantage HMO180 Days from DOS
Blue Cross PPO1 Year from DOS
Blue Essential180 Days from DOS
Blue Premier180 Days from DOS
Blue shield High Mark60 Days from DOS
Blue Shield timely filing1 Year from DOS
Bridgestone/Firestone12/31 of the following year of the service
Caremore IPA90 days from DOS
Champus1 Year from DOS
Cigna Health Springs (Medicare Plans)120 Days
Cigna timely filing limit90 Days for Participating Providers/180 Days for Non-par Providers
Citrus1 Year from DOS
Coventry180 Days from DOS
Downey IPA60 Days from DOS
Evercare60 Days from DOS
Fire Fighter/Local 101415 Months from DOS
First Health3 Months from DOS
FMH6 Months from DOS
FRA15 Months from DOS
GHI- Group health Ins1 Year from DOS
Global IPA90 days from DOS for contracted and 1 Year for non-contracted
Great West (AH&L)90 Days from DOS
Healthcare Partners90 Days from DOS
Healthcare Partners90 days from DOS
Healthnet HMO90 Days from DOS
Healthnet PPO120 Days from DOS
Horizon NJ Plus365 Days from DOS
Humana180 Days for Physicians or 90 Days for facilities or ancillary providers
Humana27 Months from DOS
ILWU3 Years from DOS
Karing Physicians90 days from DOS
Keystone Health Plan East60 Days from DOS
Lakewood IPA90 days from DOS
Local 831 Health1 year from DOS
Magna Care6 Months from DOS
Marilyn Electro IND. Benefit Fund1 Year from DOS
Medicaid90 Days from DOS
Medicare Timely filing limit1Y or 365 Days from DOS
Mega Life and Health15 Months from DOS
Memoria IPA90 days from DOS
Memorial IPA90 Days from DOS
Monarch IPA90 Days from DOS
Motion Picture Ind15 Months from DOS
Mutual of Omaha1 year from DOS
NASI2 Years from DOS
Nationwide Health15 Months from DOS
Northwest OC IPA90 days from DOS
Omnicare IPA90 Days from DOS
One Healthplan15 Months from DOS
Operating Engineers1 Year from DOS
Pacificare PPO90 Days from DOS
Pioneer Medical Group60 Days from DOS
Polk Community Health Care180 Days from DOS
Principle Financial3 Years from DOS
Prospect Medical Group90 Days from DOS
PUP180 Days from DOS
Quality Health Plan1 Year from DOS
Secure Horizons90 Days from DOS
SMA1 year from DOS
So. Ca Drug Benefit1 year from DOS
Sun180 Days from DOS
Tricare12 Months from DOS
Troa/mediplus2 years from DOS
UFCW1 year from DOS
UHC Community120 Days from DOS
Unicare24 Months from DOS
Union Fidelity1 Year from DOS
United Health Care timely filing limit – UHC COMMERCIAL90 Days from DOS
United Teacher Associates15 Months from DOS
Veterans Admin90 Days from DOS
Vista120 Days from DOS
Wellcare180 Days from DOS
Writers Guild Health18 Months from DOS
Zenith1 Year from DOS
Insurance TFL limit

Allied Benefit Systems Appeal LimitAn appeal must be submitted to the Plan Administrator within 180 days from the date of denial. Contact # 1-866-444-EBSA (3272).
Mail Handlers Benefit Plan Timely Filing LimitThe claim must submit by December 31 of the year after the year patient received the service unless timely filing was prevented by administrative operations of the Government or legal incapacity. Once we pay benefits, there is a three-year limitation on the re-issuance of uncashed checks. Claim Address- MHBP Medical Claims PO Box 8402 London, KY 40742 
Mail Handlers Benefit Timely Filing Limit

The timely filing limit of all the above insurance companies is updated from reliable resources of information. Try to keep all information in the latest update and will update as per receive any new information. If there is any discrepancy please let us know through the contact form.

AmeriHealth Caritas New Hampshire Claim Filing Guidlines

AmeriHealth Caritas New Hampshire, referred to as the Plan when applicable, is obligated under its contract and in compliance with both New Hampshire and federal regulations to collect specific data related to the services provided to its members. Providers must strictly adhere to all billing requirements to promptly process claims.

Under 42 C.F.R. §438.602(b), healthcare providers seeking to join the AmeriHealth Caritas New Hampshire network must undergo screening and enrollment as Medicaid providers through the relevant New Hampshire agency. They are also required to undergo periodic re-enrollment. This requirement applies to providers within and outside the state who do not participate in the network.

Furthermore, it’s essential to note that claims for all services rendered to Plan members must be submitted by the provider who performed the services.

For Paper Claims

AmeriHealth Caritas New Hampshire

Attn: Claims Processing Department, P.O. Box 7387 London, KY 40742-7387

For EDI/Electronic Claims

Use Payer ID for AmeriHealth Caritas New Hampshire: 87716.

Claim Timely Filing

Original claims submitted to the Plan within 120 calendar days from the date of services (DOS) were
rendered or the date of discharge for inpatient hospital admissions.

  • Claims with Explanation of Benefits (EOB) from primary insurance must be submitted within 60 days of the date of the primary insurance EOB.

Corrected Claim Instructions

Re-submission of previous denied claim with corrections and requests for adjustment must be
submitted within 365 calendar days from the date of services (DOS) were rendered or compensable item swere provided.

What is the Timely Filing Limit (TFL) in Medical Billing?

The Timely Filing Limit in medical billing refers to the timeframe healthcare providers must submit claims to insurance companies for reimbursement. It represents the maximum period allowed for the submission of claims from the date of service (DOS) or the date of discharge (DOD).
Insurance companies set timely filing limits to ensure that claims are submitted on time and to maintain efficient processing of healthcare claims. Please submit claims within the specified time frame to avoid claim denials, and the provider is responsible for the cost of the services rendered.
The specific timely filing limit can vary depending on the insurance company, type of insurance plan, and state regulations. Generally, timely filing limits range from 90 days to one year from the date of service. However, it’s essential to note that different insurance companies and plans may have specific TFL , so healthcare providers must review the guidelines each payer provides.

Healthcare providers must adhere to timely filing requirements to ensure prompt service reimbursement. Filing claims within the designated time frame helps prevent claim denials and potential revenue loss. Providers should establish efficient billing processes and closely monitor claim submission timelines to meet the timely filing limits set by each insurance company.
In summary, the timely filing limit (TFL) in medical billing refers to the maximum timeframe healthcare providers must submit claims to insurance companies. Adhering to timely filing requirements is crucial for proper reimbursement and to avoid claim denials.

How to Handle Timely Filing Denial Claims?

When receiving timely filing denials in that case we have to first review the claim and patient account to check when we billed the claim that it was billed within time or after timely filing. In some case, claim was billed within time but stuck in our system or rejected by the system.

In the second scenario, claim was billed after timely filing and in 3rd scenario, the claim was billed on time but wrongly denied so we discuss all the possible ways to handle timely filing denial.

1st and 2nd Condition- If the claim was not received by the insurance company within the time we have to call insurance and ask the appeal limit of the insurance company and the correct address to resubmit the claim with an appeal if they need some medical documents we can send that with appeal also. We also have to ask the claim received date for confirmation as well.

3rd Condition- If a claim is denied by the insurance company wrongly in that case we have to call to insurance and request for reprocessing the claim because the claim was sent on time.

In the USA there are a lot of insurance companies and their timely filing limit is different as per their profile. Updated a list of timely filing limits of different insurance companies below

Healthcare providers should familiarize themselves with each insurance company’s specific filing limits to ensure claims are submitted within the designated time frame.

Insurance Timely Filing PDFs

Image credit: Total Shape

Molina Healthcare Phone Number| Molina Claim Address

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Blue Cross Blue Shield Denial Codes |Commercial Ins Denial Codes

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  • NSingh (MBA, RCM Expert)

    The author and contributor of this blog "NSingh" is working in Medical Billing and Coding since 2010. He is MBA in marketing and Having vaste experience in different scopes of Medical Billing and Coding as AR-Follow-up, Payment Posting, Charge posting, Coding, etc.

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