Timely filing limit
DefinitionThe deadline for a payer to receive a claim, counted from the date of service: 1 calendar year for Medicare, and set by contract for other payers.
Every payer sets a window for receiving claims. Miss it and the claim is denied with CARC 29, regardless of how clean or covered it was.
- Medicare: no later than 12 months (1 calendar year) after the date of service (42 CFR 424.44). A late-filing denial is not an initial determination, so it cannot be appealed, and a provider responsible for the late filing may not charge the beneficiary beyond the deductible and coinsurance that would have applied (CMS Claims Processing Manual, Ch. 1, §70). Narrow exceptions exist, such as errors by Medicare contractors or retroactive entitlement.
- Commercial and Medicaid plans: the limit is in your contract or provider manual, and many are much shorter than a year. Corrected claims and appeals have their own windows.
The deadline is about when the payer receives a valid claim. A claim rejected by the clearinghouse was never received, so its clock kept running.
Prevention is cadence: submit within days of the visit, work the rejection report weekly, and keep each payer's limits written down next to its fee schedule.