Timely Filing Limits and How to Protect Them

Timely Filing Limits#

What it is. Every payer sets a timely-filing limit — the maximum time after the date of service within which a claim must be received to be eligible for payment. Miss it and the claim is denied with CARC 29 ("The time limit for filing has expired"), usually as CO-29 (not billable to the patient).

Typical windows. Limits vary widely by payer and contract. Common ranges:

• Medicare: generally one calendar year (12 months) from the date of service.
• Many commercial payers: 90 to 180 days, though some allow up to a year.
• Medicaid: varies by state.

Always verify the specific limit in the payer contract or provider manual; do not assume.

How timely-filing denials happen. A claim sits in a work queue, is held for missing information, bounces between the wrong and right payer (an initial CARC 109), or is repeatedly rejected at the clearinghouse and never actually reaches the payer. The clock keeps running.

How to protect and appeal:

1. Submit early and follow up. Disciplined submission cadence plus automated claim-status checks (276/277) catch stalled claims before they age out.
2. Keep proof of timely filing. Clearinghouse acceptance reports, 277CA acknowledgments, and submission timestamps are the evidence that wins a CARC 29 appeal.
3. Use the payer-caused-delay argument. If a prior wrong-payer denial (CARC 109) or a payer error caused the delay, many payers reset or extend the clock; document the chain.
4. Appeal with the proof. A timely-filing appeal succeeds only with documentation showing the claim was filed on time or that the delay was the payer's fault. Without proof, these denials are routinely upheld — which is why prevention beats appeal.

In RCM: timely filing is a process-discipline metric. Aging A/R reports and automated status follow-up are the operational defenses; proof-of-filing capture is the appeal defense.