Timely Filing

The deadline by which a provider must submit a claim to a payer after the date of service. Claims submitted after the timely filing limit are denied.

Timely filing is the payer-imposed deadline for submitting claims after the date of service. Miss it, and the payer will deny the claim with no option to resubmit. You cannot bill the patient either, because the timely filing failure is your mistake, not theirs. Timely filing limits vary by payer. Medicare gives you one calendar year from the date of service. Most commercial payers allow 90 to 180 days. Some are as short as 60 days. Medicaid varies by state but is often 90 to 365 days. The clock starts on the date of service, not the date you became aware of the patient's insurance, not the date you received the referral, and not the date the patient gave you their updated insurance card. Date of service is what the payer looks at. There are exceptions. If the patient gave you incorrect insurance information and you originally billed the wrong payer, most payers will extend the timely filing limit from the date the correct payer was identified. You need documentation to support this, like the denial from the first payer showing the claim was submitted in good faith. Timely filing denials are among the most expensive because they are completely unrecoverable. There is no appeal, no resubmission, no recourse. The revenue is gone. This is why claims should be submitted within days of the service, not weeks or months. Best practices to avoid timely filing issues: submit claims daily if possible, verify insurance eligibility before every visit, follow up on unpaid claims at 30 days, and set up alerts in your billing system for claims approaching the timely filing deadline. If you are still sending claims in batches once a month, you are playing with fire.