Timely filing limits: the quiet deadline that turns revenue into write-offs

Timely filing is the deadline a payer sets for receiving a claim after the date of service. It is not a suggestion. A claim received after the limit is denied, usually with CARC CO-29, and in most cases the balance cannot be shifted to the patient. It simply disappears from the practice's revenue.

The limits vary more than people expect

• Medicare generally requires claims within one calendar year from the date of service.
• Medicaid limits are set by each state and can be considerably shorter.
• Commercial payers set limits in the provider contract. Windows of 90 to 180 days are common, and some are shorter for corrected claims.
• Appeals have their own deadlines, counted from the date on the remittance or denial letter, and each appeal level may differ.
• Secondary claims often run from the primary payer's adjudication date, not the date of service.

Where practices lose the clock

The obvious case is a claim that was never sent. The more common case is a claim that was sent, rejected at the clearinghouse for a data error, and left in a work queue nobody owns. Each day it sits, the window closes a little. By the time someone corrects and resubmits it, the payer receives it late and denies it, even though the practice believes it was filed on time.

Proof of timely filing

When a payer denies for timely filing but the practice submitted in time, the claim can often be reopened with evidence. Clearinghouse acceptance reports and payer acknowledgment transactions are the documentation that carries weight. Keep them. A practice that cannot produce an acceptance report for the original submission usually cannot win the appeal.

How to stay ahead of it

• Maintain a payer-by-payer table of filing and appeal limits, and review it whenever a contract changes.
• Submit claims daily, so a rejected batch is caught with months of runway rather than days.
• Work rejections within one business day. A rejection is not a denial yet, but it becomes one if it waits.
• Sort the A/R work queue by days-to-deadline as well as by balance, so claims approaching a limit are touched first.
• Archive acceptance reports and remittances where they can be retrieved for an appeal.

Timely filing denials are the only category where the money was earned, the claim was valid, and the practice still gets nothing. They deserve zero tolerance.