Multi-Payer Timely Filing & Appeal Deadline Matrix
Timely filing rules differ wildly by state and payer — from 90 days for New York Medicaid and commercial PPOs to 365 days for traditional Medicare Part B. Use this matrix to protect your practice cashflow from untimeliness write-offs.
Multi-Payer Timely Filing & Appeal Deadline Matrix
Never lose another claim to CARC 29. Compare initial submission cutoffs, corrected claim deadlines, and appeal windows across state Medicaid programs, Medicare MACs, and commercial PPOs.
| Payer / Program | Jurisdiction | Initial Claim Filing Limit | Corrected Claim Window | First-Level Appeal Limit | Calculator Link |
|---|---|---|---|---|---|
Texas Medicaid (TMHP)95d Limit One of the strictest Medicaid filing limits in the country. Electronic 277 timestamp is vital. | Texas | 95 days from Date of ServiceStrict cutoff from DOS | 120 days from initial remittance | 120 days from final denial | Calculate → |
New York Medicaid (eMedNY)90d Limit Requires Delay Reason Code (e.g. Code 4 or 8) if submitted beyond 90 days with valid exception. | New York | 90 days from Date of ServiceStrict cutoff from DOS | 30 days from remittance | 60 days from initial denial | Calculate → |
Florida Medicaid (AHCA)180d Limit MMA plans (Sunshine, Simply, Humana Medicaid) enforce independent filing schedules. | Florida | 180 days from Date of ServiceStrict cutoff from DOS | 90 days from EOB | 90 days from final denial | Calculate → |
California Medi-Cal180d Limit Over 6 months requires Good Cause justification or primary insurer EOB proof. | California | 180 days (6 months) from DOSStrict cutoff from DOS | 60 days from remittance | 90 days from denial | Calculate → |
Illinois Medicaid (HFS)180d Limit Strict adherence to HFS 2360 electronic billing handbooks. | Illinois | 180 days from Date of ServiceStrict cutoff from DOS | 90 days from denial | 60 days from final remittance | Calculate → |
Georgia Medicaid180d Limit CareSource, Peach State, and Amerigroup HMO plans enforce contract-specific timelines. | Georgia | 180 days from Date of ServiceStrict cutoff from DOS | 90 days from remittance | 90 days from denial | Calculate → |
Ohio Medicaid365d Limit Single Pharmacy Benefit Manager (SPBM) and NextGen central claims clearinghouse. | Ohio | 365 days (1 calendar year)Strict cutoff from DOS | 180 days from EOB | 180 days from denial | Calculate → |
North Carolina Medicaid365d Limit Standardized under NC Medicaid Direct and standard prepaid health plans. | North Carolina | 365 days from Date of ServiceStrict cutoff from DOS | 180 days from initial remittance | 90 days from denial | Calculate → |
Medicare Part B (Fee-for-Service)365d Limit Statutory 1 calendar year rule under ACA § 6404. Strict exception criteria for retro eligibility. | National (All MACs) | 365 days (1 calendar year from DOS)Strict cutoff from DOS | 120 days from Remittance (Redetermination) | 120 days (Level 1) / 180 days (Level 2 QIC) | Calculate → |
Aetna Commercial90d Limit Standard participating provider contract specifies 90 days from DOS. Non-participating is 180–365 days. | National | 90–120 days per participating contractStrict cutoff from DOS | 180 days from initial denial | 180 days from date of EOB | Calculate → |
UnitedHealthcare (UHC Commercial)90d Limit Check specific medical protocol contract; national default is 90 days for commercial network providers. | National | 90 days (standard) up to 180 daysStrict cutoff from DOS | 180 days from denial | 180 days from remittance advice | Calculate → |
Cigna / Evernorth90d Limit Participating contract window is 90 days. Dispute must be filed via Cigna Provider Portal. | National | 90 days from Date of ServiceStrict cutoff from DOS | 180 days from denial | 180 days from denial notification | Calculate → |
Humana Commercial & Medicare Advantage90d Limit Medicare Advantage claims allow up to 365 days under federal rules if contract allows, but commercial is 90d. | National | 90–180 days per contract scheduleStrict cutoff from DOS | 90 days from denial | 180 days from date of remittance | Calculate → |
Tricare (East & West Regions)365d Limit Administered by Humana Military (East) and Health Net Federal (West). | Federal / Military | 365 days from Date of ServiceStrict cutoff from DOS | 90 days from remittance | 90 days from initial EOB | Calculate → |
Workers' Compensation (Florida)30d Limit Requires DFS-F5-DWC-9 / CMS-1500 form accompanied by clinical notes and work status report. | Florida | 30 days from Date of ServiceStrict cutoff from DOS | 30 days from denial | 30 days (Petition for Resolution) | Calculate → |
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