Timely Filing Limits by Payer: Medicare, Medicaid, TRICARE and More

A timely filing limit is the deadline a payer sets for receiving a claim after the date of service. Medicare's limit is 12 months (one calendar year) from the date of service; commercial limits are set by each payer's provider rules and your contract. Published limits we could confirm on each payer's or agency's own site:

• Original Medicare (Parts A and B): 12 months from the date of service. Part B claims count from the "From" date; institutional claims with span dates count from the "Through" date.
• Medicaid: set by each state, but federal rules require the state to make providers submit all claims within 12 months of the date of service. Check your state's provider manual for the actual limit.
• TRICARE: one year from the date of service, or from the inpatient discharge date for facility charges, for care in the U.S. and U.S. territories.
• Cigna (commercial): 90 days from the date of service for participating providers and 180 days for out-of-network providers, unless law or your agreement allows more time.
• Humana (Medicare lines of business): one year from the date of service, unless your agreement or state or federal law says otherwise.
• UnitedHealthcare: its 2026 administrative guide sends you to your Participation Agreement for the limit. Its capitation and delegation supplement says UnitedHealthcare allows at least 90 days for participating providers on commercial plans, up to 180 days for nonparticipating providers, and 365 days from the through date of service for noncontracted providers on Medicare Advantage plans.
• Aetna and Blue Cross Blue Shield plans: we did not find one national number on their own sites. Aetna's limits depend on your agreement and state law. Each Blue plan sets its own rules.

Check your contract; limits vary by plan and contract. A shorter limit in your agreement, a state law, or a different product line (Medicare Advantage, Medicaid managed care, an exchange plan) can change the number.

Sources checked October 14, 2026 · Prepared by Prospyr. This update replaces an earlier version that listed day counts we could not confirm on payers' own sites. No certified-coder or billing-specialist review is claimed. CPT is a registered trademark of the American Medical Association; use the current licensed code set.

What is a timely filing limit in medical billing?

It is the window in which the payer must receive a claim. Miss it and the claim is denied, usually with claim adjustment reason code 29 ("The time limit for filing has expired"). Two details catch practices out:

• Receipt, not sending, is what counts. Medicare denies a claim when the receipt date is more than 12 months after the date of service. UnitedHealthcare's guide also counts to the date it, or its delegate, receives the claim.
• A rejected claim does not stop the clock. UnitedHealthcare's guide says rejected claims are not proof of timely filing, because a rejection needs action from you before the claim can be processed.

Medicare: 12 months, with narrow exceptions

Federal rules (42 CFR 424.44) and the Medicare Claims Processing Manual, chapter 1, section 70, set the one-calendar-year limit. Medicare allows an extension only for four reasons:

1. An administrative error by Medicare, its contractor or an agent caused the late filing.
2. The patient was granted Medicare entitlement retroactively.
3. Retroactive Medicare entitlement for a patient who also had Medicaid, where the state Medicaid agency recouped its payment six months or more after the service.
4. Retroactive disenrollment from a Medicare Advantage plan or PACE organization, where the plan recouped its payment six months or more after the service.

Medicare Advantage plans are run by private insurers and use their own claim rules. Check the plan's provider manual and your contract, not the Original Medicare limit.

Medicaid: check your state

Federal Medicaid rules (42 CFR 447.45) require each state agency to make providers submit claims within 12 months of the date of service. States can set shorter limits, and Medicaid managed care plans run by private insurers have their own. Use your state Medicaid provider manual and the managed care plan's manual.

Commercial payers: your contract decides

Most commercial payers publish a default limit and then defer to your agreement and state law. Cigna also counts consecutive-day services, such as a hospital stay, from the last date of service, and counts coordination-of-benefits claims from the processing date on the primary payer's EOB or EOP. UnitedHealthcare's supplement gives secondary claims at least 90 days from the primary payer's payment, denial or notice.

Blue Cross Blue Shield is a group of independent companies. When you treat a patient from another state's Blue plan, the BlueCard program has you file with your local Blue plan, which acts as your single point of contact. Read your local plan's provider manual for its limit.

Can you bill the patient if a claim is filed late?

Usually not. Cigna's provider terms prohibit balance billing a patient for a claim denied as late. UnitedHealthcare's guide says you cannot bill a member for claims denied for untimely filing. Under Medicare, a provider responsible for a late claim may charge the patient only the deductible and coinsurance that would have applied. Treat a timely filing denial as a cost to the practice.

How to stay inside the limits

• Verify eligibility and the exact plan (commercial, Medicare Advantage, Medicaid managed care) before the visit, so the claim goes to the right payer.
• Close and sign charts promptly; a claim cannot be built from an unsigned note.
• Set an internal submission target well ahead of your shortest payer limit.
• Review clearinghouse acknowledgment and rejection reports daily, and fix rejections right away.
• Keep proof of timely filing: the date the payer received and accepted the claim, plus the member, date of service and provider identifiers.
• Keep a short reference list of each contracted payer's limit, taken from your agreements.

For what happens after a late-filing denial, see Timely Filing Deadlines: What Happens When a Claim Is Late.

Where Prospyr fits

Prospyr supports charting, digital intake, inventory and practice operations; practices that bill insurance heavily need a separate claims solution.

Sources

• CMS, Medicare Claims Processing Manual ch. 1 §70, Transmittal 12909 (2024)
• 42 CFR 447.45, Medicaid timely claims payment
• TRICARE, Filing Claims
• Cigna, When to file claims
• Humana 2026 Provider Manual
• UnitedHealthcare 2026 Care Provider Administrative Guide
• BCBS of Texas, BlueCard Program Provider Manual
• X12, Claim Adjustment Reason Codes