Timely Filing Limit

Aetna timely filing limit

Aetna timely filing limit to submit the initial claims is 180 days from the date service rendered, for Aetna reconsideration we have to file within 180 days from the initial claim decision and appealing limit is 60 days from the previous decision.

Aetna Medicare timely filing limit

It is same as Aetna commercial time frame as stated above i.e.

  • Initial Claims: 180 days from the date service provided.
  • Reconsideration: 180 days (From the initial claim decision) and
  • Appealing limit: 60 days (From the previous decision)

Effective May 1 2023, the new filing requirement for Texas is within 95 days from the date of service. All Texas claims must be submitted within 95 days from the date service rendered.

Aetna Better Health Timely Filing Limit:

For Aetna Better Health and Aetna Better Health Kids, we should submit the claims within 180 days from the date service rendered except stated within the provider contract and claim resubmissions should be submitted within 365 days from the date of the EOB or provider remittance advice. Provider should appeal the claim within 60 days from the claim denial date unless otherwise stated within the provider contract. If you have any questions on claims processing of Aetna Better Health claims then please do contact claims inquiry department @ 1-866-638-1232(Option 3).

Aetna timely filing limit 2024 list for initial claim payment dispute:

StateTimeRemarks
Arizona1 yearParticipating Provider and Non-Participating Providers
California-HMO365 daysParticipating Provider and Non-Participating Providers
California-Traditional180 daysParticipating Provider and Non-Participating Providers
Colorado12 monthsParticipating Provider and Non-Participating Providers
Florida12 monthsParticipating Provider and Non-Participating Providers (Note: Does not apply to facility)  
Georgia2 yearsParticipating Provider and Non-Participating Providers
Indiana2 years from claim payment dateParticipating Provider and Non-Participating Providers
Kentucky2 yearsOnly Participating provider
Maryland365 daysParticipating Provider and Non-Participating Providers
New Jersey90 days from the notice of the disputed claim determination 
New Jersey18 months from the date the first payment of a claim was made 
North Carolina2 years from the original claim paymentParticipating Provider and Non-Participating Providers
Ohio2 yearsParticipating Provider and Non-Participating Providers
Oklahoma2 yearsParticipating Provider and Non-Participating Providers
Oregon18 months from the claim denialParticipating Provider and Non-Participating Providers
Rhode Island18 monthsParticipating Provider and Non-Participating Providers
Tennessee18 monthsParticipating Provider and Non-Participating Providers
Washington24 months from the denial date or payment dateParticipating Provider and Non-Participating Providers
BCBS Prefix List – Blue Cross Blue Shield Alpha Prefix lookup (medicalbillingcycle.com)
StateTimeRemarks
Arizona1 yearParticipating Provider and Non-Participating Providers
California-HMO365 daysParticipating Provider and Non-Participating Providers
California-Traditional180 daysParticipating Provider and Non-Participating Providers
Colorado12 monthsParticipating Provider and Non-Participating Providers
Florida12 monthsParticipating Provider and Non-Participating Providers (Note: Does not apply to facility)  
Georgia2 yearsParticipating Provider and Non-Participating Providers
Indiana2 years from claim payment dateParticipating Provider and Non-Participating Providers
Kentucky2 yearsOnly Participating provider
Maryland365 daysParticipating Provider and Non-Participating Providers
New Jersey90 days from the notice of the disputed claim determination 
New Jersey18 months from the date the first payment of a claim was made 
North Carolina2 years from the original claim paymentParticipating Provider and Non-Participating Providers
Ohio2 yearsParticipating Provider and Non-Participating Providers
Oklahoma2 yearsParticipating Provider and Non-Participating Providers
Oregon18 months from the claim denialParticipating Provider and Non-Participating Providers
Rhode Island18 monthsParticipating Provider and Non-Participating Providers
Tennessee18 monthsParticipating Provider and Non-Participating Providers
Washington24 months from the denial date or payment dateParticipating Provider and Non-Participating Providers
BCBS Prefix List – Blue Cross Blue Shield Alpha Prefix lookup (medicalbillingcycle.com)

Medical Billing Denials and actions – (medicalbillingcycle.com)

Top Medical Billing Denial Codes with Solutions

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