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 Names | Claims / Appeals |
|---|---|
| Aetna TFL | 120 Days Reconsideration: 180 Days Corrected Claim: 180 Days from denial Appeal: 60 days from previous decision |
| Aetna Better Health TFL - Timely filing Limit | Initial 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 Limit | Anthem BCBS TFL List |
| Ambetter | Participating 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 Limit | Participating Providers: 180 Days Non Participating Providers: 365 days |
| Cigna TFL - Timely filing Limit | 90 Days (Participating Provider) 180 Days (Non Participating Provider) |
| Coventry TFL - Timely filing Limit | 180 Days |
| GHI TFL - Timely filing Limit | In-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 Limit | 6 months |
| HIP TFL - Timely filing Limit | Initial claims: 120 Days (Eff from 04/01/2019) When its secondary payer: 120 days from the primary carrier EOB date |
| Humana TFL - Timely filing Limit | Providers: 180 Days Facilities or Ancillary Provider: 90 Days |
| Keystone First TFL - Timely filing Limit | Initial 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 Limit | Filing initial claim: 12 months Appeal: 120 days from original determination |
| Molina Healthcare TFL - Timely filing Limit | Initial 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 Limit | 90 Days |
| Tricare TFL - Timely filing Limit | 365 Days |
| UHC Community TFL - Timely filing Limit | 120 Days |
| Unitedhealthcare TFL - Timely filing Limit | Participating 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 Limit | 180 Days |
| Kaiser TFL - Timely filing Limit | Kaiser Permanente TFL List |
| Healthfirst TFL - Timely filing Limit | Healthfirst TFL List |