Claims
Timely filing limits for medical claims: federal caps and how payers differ
Timely filing limits are the deadlines for submitting a medical claim after the date of service, and they differ by payer. Medicare allows 1 calendar year, federal rules require Medicaid agencies to ask for claims within 12 months, and payers’ own pages state shorter limits: 90 days for Cigna participating providers, 120 days in Aetna’s New York supplement and 95 days for Texas Medicaid. Your contract decides which limit applies. This is general information, not legal advice. Review your payer contracts and the rules where you practice with your compliance advisor.
Published by OffshoreMeds. Facts last checked October 9, 2026. How we check our numbers.
Federal caps
The federal caps for Medicare and Medicaid
| Program | Limit | Exceptions the text lists | Source |
|---|---|---|---|
| Program: Medicare | Limit: For services furnished on or after January 1, 2010, the claim must be filed no later than the close of the period ending 1 calendar year after the date of service. | Exceptions the text lists: Extended when a Medicare contractor or agent error or misrepresentation caused the delay, or when a beneficiary was told of retroactive entitlement, among other listed cases. | Source: 42 CFR 424.44 |
| Program: Medicaid | Limit: The Medicaid agency must require providers to submit all claims no later than 12 months from the date of service. | Exceptions the text lists: None in that paragraph. States set their own limits, and the examples below are shorter. | Source: 42 CFR 447.45(d) |
Payer examples
What four payers state on their own pages
These are examples read on October 9, 2026, not a complete table, and payers change them. Use them to see how much the limit varies, then read the document that binds you.
| Payer | Stated limit | What else the page says | Source |
|---|---|---|---|
| Payer: Cigna | Stated limit: 90 days after the date of service for participating providers; 180 days for out-of-network providers. | What else the page says: For consecutive-day services such as a hospital stay, the limit counts from the last date of service. Exceptions include applicable law, a provider agreement that allows more time, and coordination of benefits. Cigna says its contract bars balance billing the patient when a claim is denied for late filing. | Source: Cigna, when to file |
| Payer: Aetna, New York | Stated limit: 120 days after the date of service. | What else the page says: Applies unless the provider and Aetna agreed a more favorable time frame or a different one is required by law. Participating providers may request reconsideration of a claim denied solely because it was untimely. | Source: Aetna state supplement |
| Payer: Texas Medicaid | Stated limit: Received by TMHP, the Texas Medicaid and Healthcare Partnership, within 95 days of each date of service, unless otherwise stated. | What else the page says: Appeals must be received within 120 days of the disposition date on the remittance report. The manual says late claims are not payable. | Source: Texas Medicaid manual |
| Payer: Illinois Medicaid | Stated limit: 180 days from the date of service for non-institutional claims. | What else the page says: Applies to initial and re-submitted claims. | Source: Illinois HFS timely filing |
Worked example
One date of service, five deadlines
The table adds each stated limit to a service on March 2, 2026. It is an illustration, not a payer rule: it adds calendar days to the date of service, and a payer may count days differently, so confirm the counting rule in the document.
| Limit | Stated by | Last day under the stated limit |
|---|---|---|
| Limit: 90 days | Stated by: Cigna, participating | Last day under the stated limit: May 31, 2026 |
| Limit: 95 days | Stated by: Texas Medicaid | Last day under the stated limit: June 5, 2026 |
| Limit: 120 days | Stated by: Aetna, New York | Last day under the stated limit: June 30, 2026 |
| Limit: 180 days | Stated by: Cigna out of network; Illinois Medicaid | Last day under the stated limit: August 29, 2026 |
| Limit: 1 calendar year | Stated by: Medicare | Last day under the stated limit: March 2, 2027 |
In practice
How to find and track the limit that applies
- Take the limit from the provider agreement or provider manual for each payer, not from a third-party table. Cigna and Aetna both say a contract or applicable law can change it.
- Record the limit, the document, the page and the date you read it, and review it when the payer sends a bulletin.
- Start the clock at the date of service, or at the last date of service for a multi-day stay where the payer says so.
- Treat resubmissions with care: Illinois says its limit applies to initial and re-submitted claims.
- Keep the clearinghouse or portal record that shows when each claim was submitted.
- Coverage and authorization errors found after the visit use up filing time, which is why insurance eligibility verification staff and prior authorization staff check before the visit.
Chasing unpaid claims before they age past a limit is the work of denial management staff, and the order of the steps for setting up that process is in how to outsource medical billing.
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Related guides
- Denial management staff
Appeals, A/R follow-up and root-cause work, measured against published denial-rate benchmarks.
- Insurance eligibility verification staff
Coverage, benefits, authorization and patient-cost checks done before the visit, not after the denial.
- Prior authorization staff
Staff who prepare, submit and track prior authorizations, with the clinical line kept where it belongs.
- How to outsource medical billing
Five steps from choosing roles to go-live, with the compliance and cost checks in the right order.
- Prior authorization timeframes (CMS rule)
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- OHIP stale-dated claims and error reports
The Ministry's three-month rule, the reports after each submission, the monthly cut-off and how to work rejected claims.
- Medicare appeal levels and deadlines
The five appeal levels for original Medicare claims, the deadline and decision-maker at each, and the 2026 and 2027 dollar thresholds.
- Medicare enrollment effective date
The later-of effective date rule, the retrospective billing window, change reporting, revalidation and deactivation, and the CAQH attestation cycle.
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