Payer Reference

Timely Filing Limits by Payer (2026), Verified Against Each Payer's Manual

By Ajay Pillai, CEO, Aayur Solutions · Updated October 2026

Every limit on this page comes from the payer's own current provider manual or from federal regulation, with a link to the exact source. We add a payer only after checking its current manual.

Quick answer: A timely filing limit is the deadline for a payer to receive a claim. Original Medicare allows 12 months from the date of service. Federal rules cap Medicaid fee-for-service filing at 12 months, and each state sets its own limit inside that. Commercial and managed care limits come from each payer's manual and your contract: BCBS Tennessee commercial allows 6 months, CareFirst allows 365 days, and CareOregon's Oregon Health Plan claims must arrive within 120 days.

Verified Limits by Payer

Payer	Line of business	Initial claim	When secondary (COB)	Corrections, reconsideration & appeals	Source
Original Medicare	Medicare FFS (Part A/B)	12 months (1 calendar year) from the date of service	—	Redetermination: 120 days from receipt of the initial determination (CMS)	42 CFR §424.44
Medicaid fee-for-service	Federal ceiling	States set the limit; federal rules cap initial filing at 12 months from the date of service	Varies by state	Varies by state; see the state guides below	42 CFR §447.45
BlueCross BlueShield of Tennessee	Commercial	6 months from the date of service (facilities: 6 months from discharge)	60 days from the date of service; facilities: 60 days from discharge or from the primary carrier's notice of payment	Written appeal within 60 days after the response to your inquiry/reconsideration	BCBST Provider Administration Manual (Oct 1, 2026)
BlueCross BlueShield of Tennessee	Federal Employee Program (FEP) / PSHB	6 months from the date of service (facilities: from discharge). Out-of-network providers: by Dec 31 of the year after the service	60 days, as for commercial	Per the FEP dispute process	BCBST Provider Administration Manual (Oct 1, 2026)
BlueCross BlueShield of Tennessee	Medicare Advantage	1 year from the date of service (inpatient: from discharge)	1 year from the date of service or discharge, or 60 days from the primary's notice of payment, whichever is later	Reconsideration within 18 months of the initial denial (remittance date); appeal within 60 days of the reconsideration response	BCBST Provider Administration Manual (Oct 1, 2026)
BlueCare Tennessee (TennCare)	Medicaid managed care	120 days from the date of service	See TennCare rules	See the Tennessee guide	Tennessee guide (TennCare Policy PAY 13-001)
CareOregon	Oregon Health Plan (Medicaid / CCO)	120 days from the date of service (OAR, per the manual)	365 days from the date on the primary payer's EOB	Corrected claims and appeals: 365 days from the remit date of the original submission	CareOregon Provider Manual (Oct 2026)
CareOregon Advantage	Medicare Advantage	1 calendar year from the date of service	Secondary claim for dual members is created automatically by CareOregon	Provider appeals must be received within 365 days of the original remittance advice date	CareOregon Provider Manual (Oct 2026)
CareFirst BlueCross BlueShield	Commercial (MD, DC, Northern VA)	365 days from the date of service, unless the member's contract or health plan says otherwise (institutional: from service or discharge)	—	Timely-filing rejection: reconsideration within 6 months of the rejection notice, with proof of timely submission. Institutional inquiries: within 180 days of the EOB	CareFirst Provider Manual; Institutional Manual

Checked against the linked documents on October 24, 2026. A provider agreement or member benefit plan can set a different limit. When your contract and the manual differ, follow the contract and keep a copy on file.

How to Read These Limits

Know when the clock starts. Most limits run from the date of service, but inpatient claims usually run from discharge, and secondary claims often run from the primary payer's payment notice or EOB.
Secondary claims have their own clock. BCBST commercial gives only 60 days when it is secondary, while CareOregon gives 365 days from the primary EOB.
Corrections and appeals are separate deadlines. CareOregon allows 365 days from the original remit for corrected claims and appeals, and BCBST Medicare Advantage allows 18 months to request a reconsideration.
Keep proof of timely filing. Save the payer or clearinghouse acceptance report, such as the 277CA acknowledgment BCBST names as proof. Rejection reports do not count.
Late claims usually can't be billed to the patient. CareFirst's manual says so explicitly. A late-filing denial normally arrives as CARC CO-29.

Worked example (illustrative, not client data): A patient with BCBST commercial coverage sees a physician on March 3. If BCBST is primary, the claim must be filed within 6 months, by September 3. If another plan is primary and BCBST is secondary, the manual gives an individual provider 60 days from the date of service, so the secondary claim is due by May 2, even if the primary payer hasn't paid yet. (For facilities, the 60 days can also run from discharge or from the primary's notice of payment.) Secondary claims held back while waiting for the primary EOB are a common way to miss this deadline, so check the primary claim status early and ask BCBST how to handle a primary that is still pending.

Medicaid Filing Limits by State

Medicaid limits vary by state and by managed care plan. Each guide below lists the state rule, the managed care plans, and the sources it was checked against.

Frequently Asked Questions

A timely filing limit is the deadline for a payer to receive a claim, counted from the date of service (or the discharge date for inpatient claims). Claims received after the limit are denied, usually with CARC CO-29, and in most cases the provider cannot bill the patient instead.

Original Medicare requires claims to be filed within 12 months (one calendar year) of the date of service under 42 CFR 424.44. Medicare Advantage plans set their own limits by contract; for example, BCBST Medicare Advantage allows 1 year and CareOregon Advantage allows 1 calendar year.

For commercial claims, BCBS Tennessee is the shortest at 6 months from the date of service, and CareFirst allows 365 days. CareOregon's Oregon Health Plan claims must be filed within 120 days. Always check your own provider agreement, which can set a different limit.

It can. Payer manuals state the standard rule, but a provider agreement or a member's benefit plan can set a different deadline. CareFirst's manual, for example, applies 365 days unless the member's contract or health plan specifies differently. Keep the limit from your own agreement on file for each payer.

Keep the payer's or clearinghouse's acceptance report. BCBST names the 277CA claim acknowledgment as proof for electronic claims, and CareFirst asks for clearinghouse confirmation that it accepted the claim. Rejection reports with errors do not count as proof.

Sources

Educational content only, not legal or billing advice. Payer manuals change; confirm against the current manual and your contract before relying on a deadline. See our methodology.

Timely Filing Denials Are Lost Revenue

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Timely Filing Limits by Payer (2026), Verified Against Each Payer's Manual

Verified Limits by Payer

How to Read These Limits

Medicaid Filing Limits by State

Texas

California

Florida

New York

Georgia

Illinois

Ohio

Pennsylvania

North Carolina

Michigan

Arizona

Washington

Colorado

Virginia

Tennessee

New Jersey

Massachusetts

Maryland

Indiana

Missouri

Wisconsin

Oregon

Nevada

Louisiana

Frequently Asked Questions

Sources

Timely Filing Denials Are Lost Revenue