Timely filing limits by payer: the deadlines we could verify

The short answer: in Texas, a contracted provider must file a claim with a state-regulated HMO or PPO within 95 days of the date of service unless the contract allows longer, or lose the right to payment. Texas Medicaid is also 95 days from the date of service. Original Medicare is 12 months, TRICARE is one year, and VA Community Care Network claims are 180 days. Self-funded employer plans and commercial contracts set their own limits, which can be far shorter than Medicare's, so the safe rule is to send every claim within a week of the service and keep proof that each one was accepted.

The verified limits

Payer or plan type	Filing limit	Good to know	Source
Texas fully insured HMO, PPO or EPO (contracted providers)	95 days after the date of service, unless the contract extends it	Missing it forfeits the right to payment, except after a catastrophic event, and an in-network contract won't let you shift the loss to the member. Plans TDI doesn't regulate (self-funded) aren't covered.	Insurance Code §843.337 (HMOs), §1301.102 (PPOs); TDI prompt pay guidelines
Texas Medicaid (fee-for-service, TMHP)	95 days from the date of service	Appeals within 120 days of the last denial or adjustment; every claim final within 24 months of the date of service. A deadline on a weekend or holiday moves to the next business day. The rule lists exceptions, such as eligibility granted after the service.	1 TAC §354.1003
Texas Medicaid managed care (STAR, STAR+PLUS, STAR Kids, CHIP)	Set in each MCO's provider manual and contract	Check each plan's manual; don't assume it matches TMHP's.	Your MCO's provider manual
Original Medicare	12 months after the date of service	The regulation lists limited exceptions, such as retroactive Medicare entitlement or an administrative error by Medicare.	42 CFR §424.44
TRICARE	One year after the service	Texas is in TRICARE West. See our TRICARE credentialing guide.	32 CFR §199.7
VA Community Care Network (authorized care)	180 days from the date of service	Send to the third-party administrator named on the referral (TriWest or Optum, by region), not to VA.	VA, Veteran care claims
Self-funded employer plans	What the plan document and your contract say	Texas's 95-day rule doesn't apply. Out of network, the plan's own claim terms govern.	The plan or the administrator's provider manual

The Texas 95-day rule is a floor for state-regulated plans: a contract can give you longer, not shorter. If your contract says 90 days and the plan is fully insured, ask the plan and TDI which applies before you let a claim run past 90.

Commercial plans: where your number is

Every major commercial payer publishes its filing limits, and they vary by product (commercial, Medicare Advantage, Medicaid), by network status and by state. Billing blogs repeat numbers that are years old or belong to another state's product. Get yours from:

1. Your participation agreement or facility contract. Search it for "timely," "filing" and "corrected claim." This is the number that binds you.
2. The payer's provider manual or administrative guide for your state and product, including its behavioral health supplement if a separate company manages that benefit (see carve-outs).
3. Provider services, if the first two disagree. Write down the rep's name, the date and the call reference number.

When you sign a new contract, put the filing limit, the corrected-claim limit and the appeal window on your checklist. Our credentialing service includes a contract review checklist that flags exactly these terms, and negotiating insurance rates covers what else to read before you sign.

How the clock works

• It starts on the date of service, not the day the note was signed or the day you found out about the insurance. For per diem IOP and PHP billing, each day is its own date of service with its own deadline. For institutional stays, some rules count from discharge; check yours.
• Only an accepted claim stops it. A claim rejected by the clearinghouse or the payer's front-end edits was never filed. If you resend it on day 100, it's late, even though you first tried on day 20.
• Corrected claims have their own clock. Many payers set a separate window for a replacement claim (frequency code 7), counted from the original's processing date. Find it in the manual.
• Secondary claims usually run from the primary payer's payment or denial date, not the date of service. Check each plan's coordination-of-benefits terms.
• Weekends and holidays: Texas Medicaid moves a deadline that falls on one to the next business day. Don't assume other payers do.

Proof of timely filing

If a payer denies a claim as late (CARC 29), you win only with paper. What counts, strongest first:

1. The payer's acknowledgment (the X12 277CA, or the payer portal's received date) showing the claim accepted, with the payer's claim number.
2. The clearinghouse's acceptance report showing the date it accepted and forwarded the claim to that payer ID.
3. Another payer's denial, dated, when you first billed the wrong plan in good faith (for example the medical plan before you learned about a behavioral health carve-out). Texas's HMO statute (§843.337) lists information from another payer showing timely submission among the proof an HMO must accept.
4. A dated call log with a reference number, if the payer told you the claim was on file.

A printout of your own billing screen with a "sent" date is weak on its own. Keep the acknowledgments. Then appeal with the timely-filing letter in our appeals guide.

When a claim is already late

• Send it anyway, today, with any proof you have and a short cover note. Some contracts and rules have exceptions you won't learn about unless you file.
• Check the exceptions: retroactive eligibility (Medicaid's rule lists cases; Medicare's lists retroactive entitlement), a catastrophic event (Texas), or a payer error.
• Don't bill the client for a claim you filed late with an in-network plan. The contract almost always makes it your loss.
• Find out why it was late and fix that: a credentialing gap, a missing authorization, a note left unsigned, or claims that rejected without anyone noticing. In our own program, the biggest risk wasn't one slow claim; it was a batch that sat unsent in the billing system while everyone assumed it had gone out.

Build your own payer table

One row per payer and product you bill. Review it when a contract renews and once a year.

Column	Example entry (made up)
Payer and product	"Plan A, commercial PPO, fully insured (TDI on card)"
Who processes behavioral health	"Plan A's behavioral health company, payer ID on back of card"
Filing limit	"95 days from DOS (contract §4.2)"
Corrected-claim limit	"From original processing date: see manual p. 31"
Appeal window and address	"In the denial letter; portal upload"
Where it's written	"Contract §4.2; provider manual 2026 edition"
Last checked	"Oct 2026, by billing lead"

Then set one internal rule tighter than all of them. Ours: every claim out within 7 days of service, and any claim with no acknowledgment after two business days gets a look the same week.

How Cima keeps claims inside the limit

• A filing limit in Settings (95 days by default for Texas practices). Set it to the shortest limit among your payers.
• Every claim is checked against it: two weeks before the limit the claim says "your filing limit is close, send it now," and past it the claim says how many days old it is and to send it today with proof.
• A history that can't be edited: every send, clearinghouse and payer acknowledgment, payment and denial is dated on the claim and kept, so the proof for a timely-filing appeal is already there.
• Claims start when the note is signed, so nothing waits for someone to remember to bill it. See billing and claims and what claims cost.

For Texas plans, the same statute that sets the 95-day limit also sets how fast the plan must pay you: see the Texas prompt pay law. And for the billing set-up itself, see Cima Consulting's services.

Questions

What is the timely filing limit in Texas?

For state-regulated HMOs and PPOs, a contracted provider must submit the claim within 95 days of the date of service unless the contract allows longer (Insurance Code §843.337 and §1301.102). Texas Medicaid fee-for-service is also 95 days (1 TAC §354.1003). Self-funded employer plans aren't covered by the state rule and set their own.

What is Medicare's timely filing limit?

12 months after the date of service, under 42 CFR §424.44, with narrow exceptions such as retroactive entitlement or an error by Medicare.

Does a rejected claim count as filed on time?

No. A claim that was rejected before processing was never received by the payer. Only an accepted claim stops the clock, which is why you should check acknowledgments within a couple of days of sending.

Can you appeal a timely filing denial?

Yes, if you have proof the claim was accepted on time (the payer's acknowledgment or the clearinghouse acceptance report), or that you billed another payer first in good faith and have its dated denial. Without proof, a timely filing denial almost never changes.

Can I bill the patient if I missed the filing deadline?

Not for an in-network plan: the contract makes a late claim the provider's loss, and Texas law takes away the right to payment for a late claim to a state-regulated plan. Write it off and fix the reason it was late.

Why don't you list Aetna, Cigna, UnitedHealthcare and BCBS limits?

Because they vary by product, network status, state and contract, and the copies online are often out of date. The number that binds you is in your participation agreement and the payer's current provider manual for your state; put it in your payer table with the page it came from.

Sources

• Texas Insurance Code chapter 843 (HMOs, §843.337) and chapter 1301 (preferred provider plans, §1301.102); Texas Senate Research Center, bill analysis of SB 418 (2003)
• Texas Department of Insurance, Prompt pay guidelines
• 1 TAC §354.1003, Texas Medicaid time limits for submitted claims
• 42 CFR §424.44, Medicare time limits for filing claims
• 32 CFR §199.7, TRICARE claims submission
• U.S. Department of Veterans Affairs, Veteran care claims (Community Care Network, 180 days)