Timely Filing Limit - Healthcare

Timely Filing Limit of Insurances

Timely Filing Limit:

Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims.

If claims submitted after the timely frame set by insurances, then those claims will be denied by insurance companies as CO 29-The time limit for filing has expired.

Whenever claim denied as CO 29-The time limit for filing has expired, then follow the below steps:
  • Review the application to find out the date of first submission. If the first submission was after the filing limit, adjust the balance as per client instructions.
  • If claim history states the claim was submitted to wrong insurance or submitted to the correct insurance but not received, appeal the claim with screen shots of submission as proof of timely filing(POTF) and copy of clearing house acknowledgement report can also be used.
  • If we have clearing house acknowledgement date, we can try and reprocess the claim over a call.
  • If previous notes states, appeal is already sent. Reach out insurance for appeal status.
Insurance NamesClaims / Appeals
Aetna TFL120 Days

Reconsideration: 180 Days

Corrected Claim: 180 Days from denial

Appeal: 60 days from previous decision
Aetna Better Health TFL - Timely filing LimitInitial Claims: 180 Days
Resubmission: 365 Days from date of Explanation of Benefits
Appeals: 60 days from date of denial
Anthem Blue Cross Blue Shield TFL - Timely filing LimitAnthem BCBS TFL List
AmbetterParticipating provider: 120 Days
Non Participating provider: 365 Days

Reconsideration or Appeals: 365 Days from the date of the Exaplantion of Payment

Ambetter TFL-Timely filing Limit Complete List by State
Amerigroup TFL - Timely filing LimitParticipating Providers: 180 Days

Non Participating Providers: 365 days
Cigna TFL - Timely filing Limit90 Days (Participating Provider)

180 Days (Non Participating Provider)
Coventry TFL - Timely filing Limit180 Days
GHI TFL - Timely filing LimitIn-Network Claims: 365 Days
Out of Network Claims: 18 months
When GHI is seconday: 365 Days from the primary EOB date
Healthnet Access TFL - Timely filing Limit6 months
HIP TFL - Timely filing LimitInitial claims: 120 Days (Eff from 04/01/2019)

When its secondary payer: 120 days from the primary carrier EOB date
Humana TFL - Timely filing LimitProviders: 180 Days

Facilities or Ancillary Provider: 90 Days
Keystone First TFL - Timely filing LimitInitial claims: 180 Days
Resubmission of previously denied claims: 365 days from the DOS

Submission as seconday claim: 60 days from the primary EOB date
Medicare TFL - Timely filing LimitFiling initial claim: 12 months

Appeal: 120 days from original determination
Molina Healthcare TFL - Timely filing LimitInitial claims: 1 Calender year from the DOS or Discharge date

When its secondary payer: 180 calendar days from Primary Explanation of Benefits date
Prospect Medical Group - PMG TFL - Timely filing Limit90 Days
Tricare TFL - Timely filing Limit365 Days
UHC Community TFL - Timely filing Limit120 Days
Unitedhealthcare TFL - Timely filing LimitParticipating Providers: 90 days
Non Participating Providers: 180 Days
If its secondary payer: 90 days from date of Primary Explanation of Benefits

Unitedhealthcare timely filing limit for appeals: 12 months from original claim determination
Wellcare TFL - Timely filing Limit180 Days
Kaiser TFL - Timely filing LimitKaiser Permanente TFL List
Healthfirst TFL - Timely filing LimitHealthfirst TFL List