Timely Filing Limit for Claims in Medical Billing 2026

Key Points

• The timely filing limit of Medicaid refers to the maximum period a provider has to submit a claim after the date of service.
• Filing deadlines are set by each state's Medicaid program and can vary, but they are usually 90 days to 12 months.
• Claims submitted after the deadline are often denied, unless specific exceptions apply.
• Providers must maintain accurate records and follow state-specific billing manuals (and health plan provider manuals, when applicable) to remain compliant.
• Appeals and resubmissions may be allowed if timely filing proof exists, such as eligibility updates or retroactive coverage.

What Is the Timely Filing Limit of Medicaid?

The timely filing limit is the deadline established by Medicaid for providers to submit claims for reimbursement. This period typically begins on the date of service, and many Medicaid programs use the date of discharge or last date of service for inpatient hospital or nursing facility claims.

Failure to meet this limit typically results in a denied claim, meaning the provider cannot be paid.

What Sets a Medicaid Filing Deadline in 2025?

In 2025, the “right” filing deadline depends on where the claim is going and how the member is covered:

• Medicaid fee-for-service (FFS) / Medicaid Direct: The state’s fiscal intermediary (claims processor) and Medicaid provider manuals define the filing window.
• Medicaid managed care (MCO) claims: The member’s health plan contract and the plan’s provider manual may define the timely filing timeframe and corrected-claim rules.
• Coordination of benefits (COB) / third-party liability (TPL): Some programs measure timeliness from the date the primary payer processes the claim (or require specific documentation if the claim is late due to a primary payer delay).

Because Medicaid is state-administered and often plan-administered, providers should always confirm the current billing guide for their state and the member’s plan.

Common Medicaid Filing Limits by State

While exact rules must be confirmed with each state's Medicaid billing manual (and the member’s MCO provider manual when applicable), common deadlines include the examples below.

If you run a multi-state operation, build a state-by-state payer matrix that includes: claim type (CMS-1500/837P vs UB-04/837I), FFS vs MCO routing, timely filing days, corrected claim rules, and proof-of-timely-filing requirements.

Exceptions and Extensions

Medicaid programs may allow exceptions to the timely filing limit under certain conditions, such as:

• Retroactive eligibility: When a patient is granted Medicaid coverage after the service date.
• Third-party liability (TPL) / COB: When Medicaid is secondary to another payer and billing is delayed.
• System errors: When Medicaid or the plan’s processing issues prevent timely submission.
• Disasters or emergencies: Some states and plans extend filing deadlines during declared emergencies.

Documentation is essential when requesting an extension.

Proof of Timely Filing

When you need to dispute a timely filing denial, the most common requirement is proof that the claim (or a substantially similar original claim) was submitted within the filing window.

Common proof-of-timely-filing items include:

• Clearinghouse acceptance reports (EDI acknowledgements) showing submission and receipt dates
• Fiscal intermediary acceptance/rejection reports with batch or transaction identifiers
• Remittance advice (RA) showing a previously processed claim within the timeframe
• Eligibility records showing retroactive coverage or corrected eligibility spans
• Primary payer EOB/EOP details in COB situations (when required by the program or plan)

Operationally, this is why providers should keep electronic and paper records of submission dates and retain supporting reports in a central, searchable location.

Why Timely Filing Rules Matter

Timely filing rules protect Medicaid programs from late or duplicate claims while encouraging providers to maintain efficient billing systems. For providers, missing the filing limit can mean losing reimbursement entirely.

To avoid denials, providers should:

• Verify Medicaid eligibility at the time of service (and re-verify before billing when appropriate).
• Submit claims as early as possible.
• Keep electronic and paper records of submission dates.
• Review remittance advice for rejections and refile quickly if needed.
• Standardize corrected-claim and reconsideration workflows (including required forms, attachments, and resubmission windows).

Frequently Asked Questions

What is the standard timely filing limit for Medicaid?

There is no single standard. Most states and plans require filing within 90 days to 12 months of the service date, but the exact deadline can change based on whether the claim is Medicaid FFS or Medicaid managed care.

Is Medicaid timely filing based on date of service or date of discharge?

Many programs measure timely filing from the date of service for professional claims, and from the date of discharge or last date of service for inpatient stays. Always confirm the rule that applies to the specific claim type and payer routing.

Does timely filing differ for Medicaid managed care (MCO) vs Medicaid fee-for-service (FFS)?

Yes. Medicaid FFS deadlines are typically defined by the state Medicaid program and fiscal intermediary. Medicaid managed care deadlines are often defined by the health plan contract and the plan’s provider manual.

Can providers appeal a denied Medicaid claim for late filing?

Often, yes—but only if the program or plan allows a timely filing exception and the provider can produce acceptable proof (such as retroactive eligibility documentation, COB/TPL documentation, or proof the original claim was submitted within the window).

What is “proof of timely filing” in Medicaid?

Proof of timely filing is documentation showing the claim was submitted on time, such as clearinghouse acceptance reports, batch reports, remittance advice, or other payer-specific evidence accepted by the Medicaid program or plan.

Does the timely filing clock restart if a claim is rejected?

Rules vary. Some Medicaid programs and plans allow corrected claims or resubmissions when the original claim was submitted timely, but they may require specific documentation, delay reason reporting, or submission within a separate resubmission window.

How do corrected claims and resubmissions affect timely filing?

Many programs treat corrected claims as time-sensitive and may require that corrections be submitted within a defined window after the remittance date. Always follow the payer’s corrected-claim instructions and include any required indicators and attachments.

How can a multi-state provider manage timely filing limits efficiently?

Create a payer matrix by state and by plan, then build billing SOPs that standardize: eligibility verification, EDI tracking, denial follow-up, corrected-claim steps, appeal steps, and proof-of-timely-filing storage.

Conclusion

The timely filing limit of Medicaid is a critical rule for providers. Since Medicaid is state-administered (and often managed through health plans), filing deadlines vary, often ranging from 90 days to 12 months. Claims submitted after this period are usually denied, unless an exception applies.

Providers should stay familiar with their state's Medicaid billing manual and the member’s health plan requirements, submit claims promptly, and keep thorough documentation. By doing so, they protect their reimbursement and ensure compliance with state regulations.

Next step: If you want your compliance documentation and billing workflow aligned for your state, use the All-States licensing map or book a licensing consultation.