Timely filing and appeal deadline reference
Deadlines decide what is recoverable. Medicare's are set by CMS; everything else is set by contract or state rule, so the ranges below are typical, not guaranteed. In an engagement we take the actual limit from each of your payer contracts and attach it to every claim.
| Payer type | Timely filing limit | Appeal window | Authority |
|---|---|---|---|
| Medicare fee-for-service | 1 calendar year from the date of service (CMS) | Redetermination: 120 days from the initial determination. Reconsideration: 180 days from the redetermination. ALJ: 60 days from the reconsideration (CMS) | CMS |
| Medicare Advantage | Per plan contract; often 90 days to 1 year | Reconsideration typically 60 days from the denial notice; automatic IRE review if upheld | Plan contract |
| Medicaid (state) and managed Medicaid | Varies by state; often 90 days to 1 year | Varies by state and plan; state fair hearing available | State program / plan |
| Commercial PPO / HMO / POS | Per contract; commonly 90–180 days from the date of service | Per contract; commonly 60–180 days from the denial | Payer contract |
| Workers' compensation | Per state rules; often 1 year, sometimes less | State fee-schedule dispute process | State workers' comp board |
| Auto / liability | Per state PIP or med-pay rules | Carrier dispute; state insurance department | State insurance code |
| Dental plans | Per contract; commonly 90 days to 1 year | Per contract; commonly 60–180 days | Carrier contract |
Three rules that save claims
- Deadlines run from the date of service (filing) and from the denial date (appeal), not from when your team noticed.
- A corrected claim keeps the original filing date when it is submitted as a correction (frequency code 7), not as a new claim.
- Proof of timely filing is the clearinghouse acceptance report or the payer's 277 acknowledgment. Keep them for every claim; a CO-29 denial without proof is a write-off, with proof it is an appeal.
How we use this
Every claim in a Recovery opportunity report carries two dates: filing limit and appeal limit. Claims within 30 days of either are worked first regardless of balance. See the triage methodology.
Sources
- CMS, Medicare timely filing requirements
- CMS, Original Medicare appeals: five levels and deadlines
- Medicare.gov, Claims and appeals (Medicare Advantage and Part D appeals)
Figures attributed to a source are that source's; commonly used benchmarks are labeled as such. Verify deadlines against your own payer contracts.