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Timely Filing Limits: Medicare, Medicaid by State and Major Payers (2026)

A timely filing limit is the last day a payer will accept a claim for a service. Miss it and the claim can be denied no matter how correct it is. This page lists the limit for Original Medicare, TRICARE, VA community care and 45 state Medicaid programs, each checked against the program’s own rule or manual, and calculates the deadline for a specific date of service.

Rules checked September 18, 2026. Every limit links to the official document it came from. Your payer contract, a managed care plan’s own rules, or a program exception can change the limit for a particular claim.

  • 1 calendar yearOriginal Medicare, from the date of service
  • 12 monthsThe federal outer limit for Medicaid claims
  • 90 daysThe shortest state Medicaid limits verified here: Massachusetts, New Mexico and New York

What a Timely Filing Limit Means in Practice

Every payer sets a window, measured from a starting date, within which it must receive a claim. Four details decide whether a claim is on time, and they differ between payers:

  • The starting date. Most rules count from the date of service. Some use the discharge date or the last date of service for inpatient stays (Ohio, North Carolina and Texas Medicaid), and a few count from the month of service rather than the day (Medi-Cal and South Dakota Medicaid).
  • Received, not sent. The rules on this page are written around the date the payer receives the claim. A claim mailed or transmitted on the last day can still be late.
  • What counts as filed. Some programs count a claim only once it is accepted into their system. Idaho Medicaid requires an internal control number (ICN) and Washington Apple Health a transaction control number (TCN) within the limit.
  • Corrections have their own clock. A corrected or resubmitted claim often has a different limit from the original. Oregon allows 18 months for a denied timely claim, Pennsylvania 365 days for resubmissions, and Washington 24 months for resubmissions and adjustments.

Medicare Timely Filing Limit

For Original Medicare (Part A and Part B), a claim must be filed no later than the close of the period ending one calendar year after the date of service. That rule is set in federal regulation, 42 CFR 424.44(a), and applies to services furnished on or after January 1, 2010.

  • Original Medicare1 calendar year after the date of service. Example: a service on March 10, 2026 must be filed by March 10, 2027.
  • When the limit is extended42 CFR 424.44(b) extends the time when an error by a Medicare contractor or HHS employee caused the delay, when the beneficiary’s Medicare entitlement was granted retroactively, and in two related cases where retroactive entitlement, or retroactive disenrollment from a Medicare Advantage or PACE plan, led Medicaid or the plan to recover its payment six months or more after the service.

This rule covers Original Medicare claims. Medicare Advantage plans publish their own filing limits in their provider contracts and manuals, so check the plan for those claims.

Medicaid Timely Filing Limits by State

Federal regulation sets the outer limit: a state Medicaid agency must require providers to submit all claims no later than 12 months from the date of service (42 CFR 447.45(d)(1)). States can set a shorter limit, and many do. The list below covers each state’s fee-for-service program, meaning claims sent to the state Medicaid agency or its fiscal agent.

Medicaid managed care plans set their own limits. North Carolina’s Medicaid Managed Care health plans work to 180 days from the date of service or discharge, and TennCare managed care organizations to 120 days, while North Carolina’s own fee-for-service program allows 365 days. For a managed care member, check the plan’s provider manual.

Of the 45 programs verified here, 17 have a limit shorter than 12 months:

  • 90 days: Massachusetts, New Mexico, New York
  • 95 days: Texas
  • 120 days: Tennessee (claims to TennCare managed care organizations)
  • 180 days: Illinois, Indiana, Nevada (in-state claims without other insurance), North Dakota, Pennsylvania, Vermont
  • 6 months: Arizona, Nebraska, Oklahoma
  • 6 months counted from the month of service: California, Georgia, South Dakota

The other 28 verified programs allow 12 months, one year or 365 days. For 6 programs we could not open a current official source when this page was checked, so no number is shown for them.

TRICARE and VA Community Care

  • TRICAREClaims must be filed no later than one year after the services are provided. A claim returned for more information has until the later of one year after the service or 90 days from the date it was returned. Source: 32 CFR 199.7(d).
  • VA community careA community care provider must submit a claim to VA no later than 180 days after the date the care or service was furnished. Source: 38 U.S.C. 1703D(b).

Commercial Payers

Commercial limits are set by the provider contract, and the same payer can have different limits by state, product and network status. Where a payer publishes a default, it is shown below; if your agreement states a different limit, the agreement applies.

  • Cigna, participatingCigna’s provider guidance allows claims from participating providers up to 3 months (90 days) after the date of service.
  • Cigna, out-of-networkOut-of-network claims are allowed up to 6 months (180 days) after the date of service. Cigna also states that its contract prohibits balance billing a patient for a claim denied because it was filed late. Source: Cigna, When to File.
  • UnitedHealthcareThe 2026 administrative guide ties the limit to the participation agreement rather than one national number. Its worked example uses a 90-day agreement counted from the last date of service, and says every correction must also arrive inside that window. Source: 2026 UnitedHealthcare Care Provider Administrative Guide.
  • Aetna, Humana and Blue plansWe did not confirm a current published default for these payers, so none is shown. Aetna publishes its rules in its provider manual and state supplements, and Humana in its claims payment policies. Each Blue Cross Blue Shield company sets its own.

For a payer that is not listed, choose “A limit from my payer contract” in the calculator and enter the number of days or months from your agreement.

Why Published Timely Filing Lists Disagree

Checking each rule against its source turned up several differences from the lists that are commonly repeated online:

  • New Jersey is often listed at 180 days, but the regulation text we checked (N.J.A.C. 10:49-7.2) gives non-institutional providers one year from the date of service.
  • Vermont’s General Billing and Forms Manual, dated September 4, 2026, gives Medicaid-primary claims 180 days from the begin date of service.
  • Several states count from the month, not the day. Medi-Cal and South Dakota measure six months after the month of service, so a service on the 1st and one on the 31st share a deadline.
  • Fee-for-service and managed care differ. A state’s Medicaid limit usually describes its own fee-for-service claims; managed care plans in the same state can use a shorter window.

Rules also change. Oklahoma moved to 6 months for dates of service from July 1, 2015, and North Dakota to 180 days for dates of service from January 1, 2022. A list that is not tied to a dated source can be years out of date.

What to Do When a Claim Is Close to the Limit

  1. Find the exact rule. Confirm the payer, whether the member is fee-for-service or in a managed care plan, and whether the rule counts from the date of service, the discharge date or the month of service.
  2. Get the claim accepted, not just sent. Fix front-end rejections immediately. Where a program requires an ICN or TCN within the limit, a rejected submission does not stop the clock.
  3. Check for an exception that fits. Many of the rules on this page extend the limit for retroactive eligibility, another payer’s late decision, or an error by the agency. Kentucky, for example, allows 6 months from the Medicare or other insurance payment date when that is later than 12 months from service, and Medicare extends the limit when a Medicare contractor’s error caused the delay.
  4. Keep proof of timely filing. Oklahoma accepts a denied claim as proof that a claim was filed on time. Kentucky asks for a remittance section showing the original claim was received within 12 months of the service date. Keep acceptance reports and remittance advice until the claim is paid.
  5. Check the patient-billing rules before billing a patient. Cigna’s contract prohibits billing the patient for a claim denied as untimely, and Florida’s Medicaid policy rule says a provider may not seek payment from the recipient after failing to bill Florida Medicaid correctly and on time.

Timely Filing Questions

What is the timely filing limit for Medicare?

One calendar year after the date of service for Original Medicare, under 42 CFR 424.44. Medicare Advantage plans set their own limits in their provider contracts.

Which payers have a 90-day timely filing limit?

Among the programs verified on this page, Massachusetts, New Mexico and New York Medicaid use 90 days, and Cigna’s published default for participating providers is 90 days. Many commercial contracts also use 90 days, but only the contract can confirm it.

Is the limit counted from the date of service or the date of discharge?

It depends on the rule. Most count from the date of service, while inpatient rules often count from the discharge or last date of service. Ohio, North Carolina and Texas Medicaid all say so explicitly, and Medi-Cal and South Dakota count from the month of service.

Does a rejected claim count as filed?

Not necessarily. Rules are written around the payer receiving, and in some cases accepting, the claim. Idaho Medicaid requires an ICN and Washington Apple Health a TCN within the limit.

What is the federal limit for Medicaid claims?

Twelve months from the date of service. 42 CFR 447.45(d)(1) requires state Medicaid agencies to have providers submit all claims within 12 months, and states may set a shorter limit.

Does this calculator decide whether my claim will be paid?

No. It applies the published limit to the date you enter. Exceptions, contract terms, managed care rules and the payer’s own processing can change the answer for a specific claim.

Sources and How These Limits Were Checked

Each limit on this page was read from the program’s own regulation, provider manual, bulletin or official web page on September 18, 2026, and every state entry names and links its source. Several state Medicaid websites block automated access from outside the United States. For those, we read the official document through its Internet Archive copy and give the date of that copy. Where the only readable copy was old, or where a newer version exists that we could not open, the entry says so.

If a rule has changed, or you have the current official source for a state marked as not verified, the corrections policy explains how to report it.

Related Resources

Timely filing is one of the checks a claim has to pass before it is paid. What makes a clean claim covers the rest, the claim denial management guide covers working denials once they arrive, and the ICD-10-CM validity checker confirms a diagnosis code was valid on the date of service. Texas providers can match TMHP rejection and denial codes in the TMHP rejection and EOB reference.