Timely Filing Limit for Claims in Medical Billing 2025

Healthcare is a fast-paced industry where precision and timing are critical—not just in patient care but also in the financial processes that keep practices running smoothly. One of the most important aspects of medical billing is adhering to the timely filing limit—the deadline set by insurance companies for submitting claims. Missing these deadlines can lead to claim denials, lost revenue, and administrative headaches. At Prime RCM, we’re committed to helping healthcare providers navigate these complexities as a trusted medical billing company. In this guide, we’ll break down what timely filing is, explore specific limits for major payers like Aetna, BCBS, and Medicare, and share strategies to ensure your claims are submitted on time.

What is Timely Filing in Medical Billing?

Timely filing, often abbreviated as TFL in medical billing, refers to the specific timeframe within which healthcare providers must submit claims to insurance companies for reimbursement. This deadline begins on the date of service (DOS) or, in some cases, the date of discharge for inpatient care. If a claim isn’t submitted within this window, insurers can deny it outright, leaving providers unpaid for their services.

Think of it as a ticking clock: once a patient receives care, you have a limited period—ranging from 30 days to a year, depending on the payer—to file the claim. The timely filing limit also applies to appeals for denied claims, making it a dual-purpose deadline in the revenue cycle. For example, if a physician sees a patient on March 1, 2025, and the insurer’s TFL is 90 days, the claim must be submitted by May 30, 2025, to avoid rejection.

Understanding what is timely filing is the first step to protecting your practice’s revenue. Let’s dive into the specifics of these limits for major insurance payers.

Check Also: What is Upcoding in Medical Billing?

Timely Filing Limits for Major Insurance Payers

Each insurance company sets its own timely filing limit, and these can vary by state, plan type, or provider contract. Below, we’ve outlined the standard medical billing time limits for some of the most common payers in the U.S. as of March 26, 2025. Always verify these deadlines with the payer’s provider manual or your contract, as exceptions may apply.

Aetna Timely Filing Limit

• Participating Providers: Claims must be submitted within 90 days from the date of service.
• Non-Participating Providers: The Aetna timely filing limit extends to 180 days from the date of service.
• Exceptions: For consecutive services (e.g., hospital stays), the clock starts from the last date of service. Some states allow up to 1-2 years, so check your local guidelines.

Cigna Timely Filing

• Standard Deadline: Cigna timely filing requires claims within 90 days for participating providers.
• Medicare-Related Claims: Non-participating providers have 15-27 months, while Medicare patients’ claims are due by the end of the following calendar year (or the year after if services occur in the last quarter).

United Healthcare Timely Filing Limit

• UHC Timely Filing Guidelines: Typically, 90 days for initial claims, though some plans allow up to 365 days.
• Coordination of Benefits (COB): If UHC is secondary, submit within 90 days of the primary payer’s explanation of benefits (EOB).

Medicare Timely Filing

• Medicare timely filing: Claims must be filed within 12 months (365 days) from the date of service. Exceptions exist for administrative errors or retroactive entitlements, but these are rare.

Medicaid Timely Filing Limit

• Timely Filing Limit of Medicaid: Varies by state. For example, the Medicaid NY timely filing limit is 90 days from the date of service, but some states allow up to a year. Check your state’s Medicaid agency for specifics.

Blue Cross Blue Shield (BCBS)

• Timely Filing Limit of BCBS: Generally 365 days, though this can differ by state or plan. For instance, BCBS of Texas might have a shorter window than BCBS of California.

Emblem TFL Limit

• EmblemHealth: Depending on the plan, the Emblem TFL limit ranges from 90 to 180 days for initial claims. Verify with your specific EmblemHealth contract.

Check Also: What is POS 11 in Medical Billing?

Timely Filing Limits by State

Medical billing time limits by state can add another layer of complexity, especially for Medicaid and commercial payers. While Medicare’s 365-day rule is consistent nationwide, state-specific regulations or payer policies may override standard deadlines. For example:

• New York: Medicaid’s Medicaid NY timely filing limit is 90 days, but some commercial plans allow 180 days.
• California: BCBS might extend to 365 days, while Medicaid could be as short as 60 days.
• Texas: Aetna’s standard 90-day limit applies, but state laws may offer leniency for certain claims.

The timely filing limit depends on factors like payer policies, state regulations, and whether the claim involves coordination of benefits (COB). Partnering with a medical billing company like Prime RCM can help you stay compliant across jurisdictions.

AFL vs. TFL in Medical Billing

You might encounter the term AFL in medical billing alongside TFL. While TFL (timely filing limit) refers to the deadline for initial claim submission, AFL (appeal filing limit) is the timeframe for appealing a denied claim. Some payers align these deadlines, but others don’t. For instance:

• Aetna: Appeals must often be filed within 180 days of denial, even if the initial Aetna timely filing limit was 90 days.
• UHC: The United Healthcare timely filing limit for appeals can extend to 12 months in some cases.

Understanding the difference ensures you don’t miss either deadline, maximizing your reimbursement potential.

Why Timely Filing Matters?

Failing to meet timely filing deadlines has serious consequences:

1. Financial Loss: Denied claims mean lost revenue, and most contracts prohibit balance billing patients for these denials.
2. Cash Flow Disruptions: Late submissions delay payments, straining your practice’s finances.
3. Administrative Burden: Resubmitting or appealing claims wastes time and resources.

On the flip side, adhering to TFL in medical billing:

• Ensures prompt reimbursement.
• Builds trust with payers.
• Reduces claim denials and rework.

Check Also: What is IPA in Medical Billing​?

Tips to Avoid Timely Filing Denials

At Prime RCM, we’ve seen firsthand how proactive strategies can prevent timely filing issues. Here are actionable tips to keep your claims on track:

1. Know Your Payer Deadlines: Create a cheat sheet with timely filing limits for Aetna, BCBS, Cigna, Medicare, and others you work with. Update it annually.
2. Submit Early: File claims as soon as possible—don’t wait until the deadline looms. This gives you buffer time to fix errors.
3. Leverage Technology: Use billing software to automate submissions and flag approaching deadlines.
4. Double-Check Before Submission: Ensure claims are complete and accurate to avoid rejections that could push you past the TFL.
5. Track Appeals: If a claim is denied, note the AFL and appeal promptly with supporting documentation.
6. Partner with Experts: A medical billing company like Prime RCM can streamline the process, ensuring compliance with uhc timely filing guidelines, Cigna timely filing, and more.

How Prime RCM Can Help?

Navigating timely filing limits for BCBS, Aetna, Medicare, and other payers can feel overwhelming, especially with varying rules by state and plan. That’s where Prime RCM comes in. As a leading medical billing company, we specialize in:

• Deadline Management: We track TFL and AFL deadlines for every claim.
• Error-Free Submissions: Our team ensures claims are accurate and submitted on time.
• Appeals Expertise: If a claim is denied, we handle appeals within the timely filing limit of Medicaid, BCBS, or any payer.

With Prime RCM, you can focus on patient care while we safeguard your revenue.

Conclusion

The timely filing limit for claims in medical billing is a critical factor in maintaining a healthy revenue cycle. Whether it’s the 90-day Aetna timely filing limit, the 365-day Medicare timely filing window, or the state-specific Medicaid NY timely filing limit, missing these deadlines can cost your practice dearly. By understanding what is timely filing, staying organized, and leveraging expert support from a medical billing company like Prime RCM, you can avoid denials and keep your cash flow steady.

Don’t let deadlines derail your practice’s success. Contact Prime RCM today to learn how we can help you master timely filing and optimize your billing process.