Timely filing and appeal deadlines by payer
Short answer: Original Medicare generally allows 12 months from the date of service to file a claim and 120 days from receipt of the initial determination to request a redetermination. Commercial and Medicare Advantage deadlines vary by payer, plan and contract, and are often shorter.
Your participation agreement controls. Use the published deadlines below as a starting point, then verify the deadline that applies to the specific claim.
A claim that misses the filing deadline is usually denied, and for a contracted provider that balance often cannot be billed to the patient. That makes timely filing one of the most expensive denials to get wrong.
Last reviewed: October 21, 2026
Published deadlines by payer
Important: These are published general deadlines, not a substitute for your payer contract. Filing and appeal limits can vary by plan, state, network status, claim type, and provider agreement. Always verify the deadline that applies to the specific claim.
| Payer | Claim filing limit | First-level appeal or dispute | Source |
|---|---|---|---|
| Original Medicare (fee-for-service) | 12 months from the date of service | Redetermination: 120 days from receipt of the initial determination (receipt is presumed 5 days after the notice date) | CMS Claims Processing Manual, Ch. 1; CMS redetermination |
| Medicare Advantage (all plans) | Set by the plan and your contract | Member/enrollee reconsideration: 60 days from receipt of the plan's decision (65 days from the notice date). Contracted provider payment disputes follow the plan's own provider dispute process, which is a separate track | 42 CFR 422.582; CMS Part C reconsideration |
| Medi-Cal (California, fee-for-service) | 6 months from the end of the month of service. Claims received in months 7–9 are paid at 75%, months 10–12 at 50%, and later claims are denied unless an exception applies | Claims Inquiry Form appeal: 90 days from the remittance date or the inquiry response | Medi-Cal Provider Manual: Claim Submission and Timeliness |
| UnitedHealthcare (commercial) | Set by your contract | Reconsideration and appeal: within 12 months of the original EOB, per the published guide. State and plan rules may differ | 2026 UHC Administrative Guide; UHC appeals |
| Aetna (commercial) | Per contract and applicable plan terms | Reconsideration: generally 180 days where applicable. An appeal may have a separate deadline. State, product, network status and contract terms may change the deadline | Aetna disputes and appeals |
| Cigna (commercial) | Participating providers: generally 90 days from the date of service. Out-of-network providers: generally 180 days. Contractual and legal exceptions may apply | 180 days from the payment or denial notice | Cigna claims; Cigna appeals and disputes |
| Anthem Blue Cross — California commercial | 90 days from the date of service for affected contracts, for claims received on or after October 1, 2019 | Provider dispute: 365 days from Anthem's action | Anthem CA Provider News; Anthem CA dispute flyer |
| Blue Shield of California | 12 months from the date of service unless your contract says otherwise | First-level dispute: 365 days, or longer if your contract allows | Blue Shield IPP Manual (July 2026); Blue Shield dispute process |
| Humana — Medicare Advantage | 1 year from the date of service | Provider claim dispute: 18 months from the notice | Humana 2026 Provider Manual |
| Humana — commercial | Per contract and applicable plan terms. Do not assume the Medicare Advantage rule applies | Per contract and plan terms | Humana 2026 Provider Manual |
| TRICARE | 1 year from the date of service (3 years for claims for care overseas) | Varies by region and contractor. TriWest (West Region) lists 90 days from the remittance for reconsideration | TRICARE Operations Manual, Ch. 8 §3; TriWest reconsiderations |
Some deadlines that are widely quoted online do not appear in the payers' own current documentation, so we have left them out. If a payer's guide does not state a deadline, the answer is in your contract.
Why timely-filing deadlines get missed
Most missed deadlines are not one bad decision. They are claims that sat without a next action until the window closed.
- Wrong payer on file. The claim goes to the wrong plan, and by the time the denial comes back, the clock at the right payer has been running.
- Rejections that were never worked. A rejected claim was never accepted, so it may not count as filed at all.
- Secondary claims. The secondary claim waits on the primary EOB, then gets forgotten after the primary pays.
- Retroactive eligibility. Coverage changes after the visit, and the claim has to be refiled with a different payer.
- Missing documentation. The payer asks for records, and the request sits in a queue.
- Claims sitting without a next action. Nobody owns the claim, so nobody notices it aging toward the deadline.
How to track deadlines
Aging buckets show how old your A/R is. They do not show which claims are about to lose their filing or appeal window.
Track deadlines at the individual claim level:
- Record the filing limit and the appeal limit for each payer, and the contract terms that change them.
- Calculate a deadline date for each open claim, not just its age.
- Flag claims well before the deadline, with time left to correct and resubmit.
- Keep proof of timely filing, such as clearinghouse acceptance reports, for every submission.
- Review rejections and unworked denials on a set schedule, so nothing sits without a next action.
This is part of what good A/R recovery and denial management should cover.
What to do if a deadline was missed
A late claim is not always lost, but many cannot be recovered. Check these before writing it off:
- Proof of timely filing. If the claim was submitted on time but rejected or lost, clearinghouse reports or payer acknowledgments may support a reconsideration.
- Payer exceptions. Many payers list exceptions, such as coordination of benefits delays, retroactive eligibility, or a payer request for more information.
- Retroactive eligibility. If coverage was changed after the date of service, the payer may measure the deadline from a later date.
- Documentation. Gather the dates, notices and records that explain why the claim is late.
- Contract escalation. Your provider agreement may describe a dispute process or allow more time.
The faster you act, the more options you usually have. For more on preventing repeat denials, see preventable medical billing denials.
Not sure what is aging toward a deadline?
If you already have a billing company, ask them to show you the claims closest to their filing or appeal deadlines. If they cannot, that is worth knowing. Our questions to ask a medical billing company can help.
Our free Revenue Leak Audit can help identify aging claims, unworked denials and claims that may deserve another look.
Common questions about timely filing limits
What is a timely filing limit?
It is the deadline a payer sets for receiving a claim, usually counted from the date of service. The limit depends on the payer, plan, network status and contract. Verify the applicable payer documentation for the specific claim.
What is the timely filing limit for Medicare?
For original Medicare fee-for-service, claims generally must be filed within 12 months of the date of service. Medicare Advantage plans set their own limits by plan and contract.
Is the appeal deadline the same as the filing deadline?
No. The filing deadline covers the original claim. A separate deadline usually applies to a reconsideration or appeal after the payer makes a decision, and it often runs from the date of the payer's notice.
Can a claim be paid after the timely filing deadline?
Sometimes. Proof of timely filing, payer exceptions, retroactive eligibility or contract terms may allow it, but many late claims cannot be recovered. The deadline depends on the payer, plan, network status and contract.
Does my contract override the payer's published deadline?
Payer manuals generally say the provider agreement controls where it sets different terms, and state law can require a longer period. Check your contract and the payer's current documentation for the specific claim.