Timely Filing Limits by Payer: Medicare, Medicaid

Mukesh MakwanaFounder & CEO · Hands-on medical billing & RCM across 11 specialties · Reviewed October 1, 2026

A timely filing denial is the one denial you usually cannot fix. Once a payer's filing limit has passed, the claim is closed no matter how good the documentation is. The limits differ by payer: Medicare allows one calendar year from the date of service, federal rules cap state Medicaid programs at 12 months, and commercial plans follow their contracts and state law, which can be far shorter. This page sets out the limits that come from official rules, how to prove a claim was filed on time, and how to stop these denials happening.

Filing limits from official rules

Payer	Filing limit	Source
Medicare (fee-for-service)	No later than the close of the period ending 1 calendar year after the date of service, with limited exceptions.	42 CFR 424.44
Medicaid (any state)	The state must require claims no later than 12 months from the date of service. States can set a shorter limit, so check your state's provider manual.	42 CFR 447.45(d)
Medicaid after Medicare	Where the Medicare claim was filed on time, the state may pay the Medicaid claim for the same service within 6 months after the Medicare decision.	42 CFR 447.45(d)(4)
Texas commercial (state-regulated HMO and PPO plans)	A 95-day claim filing deadline for physicians and providers licensed in Texas. For a secondary plan, the 95 days start when the primary plan's payment or denial is received.	Texas Department of Insurance, Prompt Pay FAQ
Florida commercial (state-regulated insurers)	Claims must reach the primary insurer within 6 months after the date of service (outpatient) and after the provider has the correct name and address of the patient's insurer; claims to a secondary insurer within 90 days after the primary insurer's final determination.	Florida Statutes 627.6131(3)(b)
Other commercial plans	Set by the provider contract and, for state-regulated plans, state law. Self-funded employer plans follow the plan document.	Your contract and the plan's provider manual

Medicare Advantage, Medicaid managed care and commercial plans each publish their own limits in provider manuals and contracts. Read the timely filing clause of every contract you sign, and record the limit for each payer in your billing system.

Medicare's exceptions

The Medicare rule allows extensions in narrow situations. The one that matters most to private practices is error by Medicare itself: CMS extends the filing time when it, or one of its contractors, decides that the late filing was caused by error or misrepresentation by an employee, contractor or agent of HHS acting within its authority. Other exceptions in 42 CFR 424.44(b) cover retroactive entitlement situations. Missing the date because a claim sat in a work queue is not an exception.

What a timely filing denial looks like

On a remittance advice, a timely filing denial normally carries claim adjustment reason code 29, "The time limit for filing has expired," from the X12 claim adjustment reason codes. Before writing the claim off, check two things:

Was it actually late? Payers count from different events: Medicare from the date of service, Florida's rule from the date of service and the date you had the correct insurer details, secondary claims from the primary payer's decision. A claim denied as late may have been on time under the correct starting point.
Do you have proof it was filed earlier? If the first submission was on time and rejected or lost, proof of that first filing is your appeal.

Eligibility verification (EV), benefits verification (BV), prior authorizations, and denial management at no cost for your first 30 days.

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How to prove a claim was filed on time

Clearinghouse acceptance reports. The payer's acceptance or acknowledgment report for the batch, showing the claim and the date, is the strongest evidence for an electronic claim.
Payer portal history showing the original claim number and receipt date.
Earlier denials or correspondence on the same claim, which show the payer had it before the limit.
Proof of primary payment with its date, for secondary claims that run from the primary decision.

Keep these reports for every batch. A practice that cannot show the original acceptance report usually loses the appeal.

Why claims miss the deadline

Wrong insurance on file, so the claim went to a payer that rejected it, and the right payer was billed after the limit.
Rejections nobody worked. A claim rejected at the clearinghouse or payer front end was never accepted, so it never stopped the clock.
Credentialing delays. Claims held while a provider waited for an effective date, then sent too late.
Secondary claims forgotten after the primary paid.
Short commercial limits treated as if every payer allowed a year.

How to prevent timely filing denials

Verify eligibility and the correct payer before the visit, and again when coverage changes. See our eligibility verification services.
Submit claims within days of the visit, not at the end of the month.
Work every rejection report the day it arrives, because a rejected claim is not a filed claim.
Keep a filing-limit table by payer and run a weekly report of unbilled and unpaid claims approaching each limit.
Send secondary claims as soon as the primary decision posts.
Keep acceptance reports and portal confirmations for every batch.

How Sterling Global Solution LLC handles it

We submit claims promptly, work rejections daily, track each payer's limit, and keep the proof of every submission so a timely filing denial can be appealed with evidence. When we take over a practice, we sort its open AR by how close each claim is to its limit and work the oldest first; see our AR recovery services and denial management services. For the other common denial reasons, see why insurance claims are denied and insurance companies not paying claims.

Frequently asked questions

What is the timely filing limit for Medicare?

Under 42 CFR 424.44, a Medicare claim must be filed no later than the close of the period ending 1 calendar year after the date of service, with limited exceptions.

What is the timely filing limit for Medicaid?

Federal rule 42 CFR 447.45(d) requires states to require claims no later than 12 months from the date of service. States can set a shorter limit in their provider manuals.

What does denial code CO-29 mean?

Claim adjustment reason code 29 means the time limit for filing has expired. Check whether the claim was really late under the payer's starting point, and whether you have proof of an earlier submission.

How do I prove a claim was filed on time?

Use the clearinghouse or payer acceptance report for the original submission, the payer portal history, earlier denials on the same claim, or the dated primary payment for a secondary claim.

What is the Texas timely filing limit for commercial claims?

The Texas Department of Insurance describes a 95-day claim filing deadline for physicians and providers licensed in Texas billing state-regulated HMO and PPO plans.

Sources

Code of Federal Regulations, 42 CFR 424.44 (Medicare time limits for filing claims) and 42 CFR 447.45(d) (Medicaid timely processing of claims).
Texas Department of Insurance, Prompt Pay FAQ; Florida Statutes 627.6131.
X12, Claim Adjustment Reason Codes: code 29.

Contracts and plan manuals can set different limits for commercial, Medicare Advantage and Medicaid managed care plans. This summarizes official sources and is not legal advice. How we verify this guidance.

Timely Filing Limits by Payer