When does the timely filing deadline start?

The clock starts from the date of service (DOS). For Medicare, the deadline is 365 days from DOS. Commercial carriers typically use 90 days from DOS for in-network and 180 days from DOS for out-of-network services.

Does a claim denial extend the timely filing deadline?

No. Once the timely filing deadline passes, an appeal must be filed within the plan's appeal deadline, which is separate from the filing deadline. Missing the filing deadline results in a CO-29 denial that generally cannot be overcome through appeal.

Timely Filing Deadline Requirements

What Is Timely Filing Deadline

Timely Filing Deadline refers to the maximum time permitted to submit a claim to an insurance carrier after the date of service (DOS). Medicare allows 365 days from DOS. Commercial carriers vary: UHC typically requires 90 days for in-network and 180 days for out-of-network; Anthem requires 180 days regardless of network status; Aetna requires 90 days in-network and 180 days out-of-network; Cigna typically requires 90 days from DOS. Claims submitted after the deadline receive a CO-29 denial code and are generally not recoverable through appeal.

Who It Affects

Healthcare providers, billing departments, revenue cycle managers, and practice management companies must track and comply with deadlines. Insurance carriers enforce deadlines uniformly across all claims. Patients indirectly benefit from timely filing, as missed deadlines prevent payment and can leave them liable for balance billing. Medical practices managing large claim volumes must maintain sophisticated tracking systems to catch deadlines before they expire.

Key Requirements

Calculate the deadline from the date of service, not the date the claim is prepared
Submit all claims to Medicare within 365 days from date of service
Submit UHC claims within 90 days for in-network, 180 days for out-of-network
Submit Anthem claims within 180 days from date of service
Submit Aetna claims within 90 days for in-network, 180 days for out-of-network
Submit Cigna claims within 90 days from date of service
Document the claim submission date with proof of timely filing
Maintain logs of all claims organized by deadline and carrier

Timeline and Enforcement

Timely filing deadlines begin on the date of service and are strictly enforced by all carriers. Claims submitted one day past the deadline are subject to denial. CMS and state insurance departments monitor carrier timely filing enforcement. Providers can request deadline extensions in limited circumstances, such as natural disasters or system failures, but these requests must be submitted before the deadline expires. Repeated late submissions may trigger carrier audits and network reviews.

How to Comply

Maintain a comprehensive claim tracking system organized by carrier and deadline
Set calendar reminders for carrier-specific deadlines before they expire
Establish claim submission workflows that process all claims before the deadline
Assign staff responsibility for monitoring high-volume claim deadlines
Implement claim aging reports that flag approaching deadlines weekly
Obtain proof of electronic submission (timestamp) for all claims submitted
Review denial reports monthly to identify any CO-29 timely filing denials
Request deadline extensions only if system failures prevent timely filing

Frequently Asked Questions

Does the timely filing deadline change if the patient is hospitalized?

No. The deadline is always measured from the original date of service, regardless of hospitalization status. Hospital claims and facility claims follow the same timely filing rules as outpatient services.

Can a provider request an extension of the timely filing deadline?

Rarely. Carriers may grant extensions in cases of documented system failures, natural disasters, or extraordinary circumstances. The request must be submitted before the deadline expires and must explain the circumstances preventing timely submission.

What is the appeal deadline if a timely filing denial is issued?

CO-29 timely filing denials cannot be appealed to overturn the deadline violation. However, providers can appeal to dispute whether the claim was actually submitted on time or request reconsideration based on system failure documentation.

Related Resources

Claim Submission Deadline | Appeal Deadline | CO-29 Timely Filing

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This content is provided for informational purposes only and does not constitute legal or billing advice. Timely filing deadlines vary by carrier and contract. Consult with your billing team and carrier contracts regarding specific deadlines. Altair by S7 Lab is not responsible for changes in carrier policies or their interpretation.