Billing rules don't stop at payer manuals — Medicaid structure, dominant payers, filing windows, and state law all change at the state line. Each reference below covers the payer landscape, Medicaid managed care plans, and timely filing limits for one state.
STAR managed care programs, TMHP claims, and the shortest big-state Medicaid filing window in the country.
Medicaid filing: 95 daysMedi-Cal county plans, two separate Blue plans, AB 72 balance-billing limits, and DMHC oversight.
Medicaid filing: 6 monthsSMMC managed Medicaid, the nation's densest Medicare Advantage market, and BlueCard snowbird volume.
Medicaid filing: 12 monthseMedNY's strict 90-day window, regional nonprofits like Healthfirst, and pre-federal surprise billing law.
Medicaid filing: 90 daysThree Georgia Families CMOs, Anthem's commercial dominance, and Atlanta's MA competition.
Medicaid filing: 6 monthsHealthChoice Illinois plans including CountyCare, under BCBSIL's commanding commercial share.
Medicaid filing: 180 daysNext Generation Medicaid's single front-door claims, CareSource scale, and Medical Mutual contracts.
Medicaid filing: 365 daysTwo Blues split by geography, provider-owned UPMC and Geisinger plans, and the BH carve-out.
Medicaid filing: 180 daysYoung managed Medicaid (2021), the expansion wave, and BCBS NC's single-state dominance.
Medicaid filing: 365 daysBCBSM vs Blue Care Network rules, auto-industry ERISA plans, and county-level Medicaid menus.
Medicaid filing: 12 monthsAHCCCS — America's oldest all-managed-care Medicaid — plus retiree MA density in Maricopa.
Medicaid filing: 6 monthsApple Health MCOs, two independent Blues (Premera and Regence), and tech-employer ERISA plans.
Medicaid filing: 365 daysThe RAE model — fee-for-service physical health with capitated behavioral health by region.
Medicaid filing: 365 daysCardinal Care Medicaid, two Blues by geography, and heavy FEP/TRICARE federal volume.
Medicaid filing: 365 daysTennCare's 3 MCOs after UHC's December 2025 exit, BCBST's dual commercial and MCO role, and the 120-day hard deadline.
Medicaid filing: 120 daysFive NJ FamilyCare MCOs, the nation's strongest OON balance billing law, and Horizon OMNIA tier rules.
Medicaid filing: 180 daysMassHealth's unique ACO model (~17 ACOs), the shortest Medicaid window in New England, and mandatory TPL billing.
Medicaid filing: 90 daysNine HealthChoice MCOs, Priority Partners' 2025 NCQA suspension, and CareFirst's dual commercial and MCO presence.
Medicaid filing: 12 months (FFS)MDwise exit January 2026, SB 480 PA reform, and Anthem's ~68% commercial dominance across Hoosier Healthwise and HIP.
Medicaid filing: 180 daysMO HealthNet's 12-month FFS vs. 90–180-day MCO limits, late Medicaid expansion (2021), and the 2026–27 MCO rebid.
Medicaid filing: 12 months (FFS)BadgerCare Plus with 9 MCOs, strong regional plans by geography, and ForwardHealth's rolling PA changes through 2027.
Medicaid filing: 365 daysOHP's 16 CCOs — each sets its own PA criteria and timely filing. CareOregon requires 120 days; OHA FFS allows 365.
Medicaid filing: 365 days (FFS)Statewide MCO expansion January 2026, HPN vs. UHC Community Plan distinctions, and Culinary Union trust fund plans in Clark County.
Medicaid filing: 180 days (in-state)UHC Medicaid exit December 2025, Healthy Blue LA's 90-day MCO limit vs. 365-day FFS, and BCBS LA's independence from Anthem.
Medicaid filing: 365 days (FFS)More states are added regularly. Need one that isn't here yet? Request it — reader requests set the build order.
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