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 for initial claim payment dispute:
| State | Time | Remarks |
| Arizona | 1 year | Participating Provider and Non-Participating Providers |
| California-HMO | 365 days | Participating Provider and Non-Participating Providers |
| California-Traditional | 180 days | Participating Provider and Non-Participating Providers |
| Colorado | 12 months | Participating Provider and Non-Participating Providers |
| Florida | 12 months | Participating Provider and Non-Participating Providers (Note: Does not apply to facility) |
| Georgia | 2 years | Participating Provider and Non-Participating Providers |
| Indiana | 2 years from claim payment date | Participating Provider and Non-Participating Providers |
| Kentucky | 2 years | Only Participating provider |
| Maryland | 365 days | Participating Provider and Non-Participating Providers |
| New Jersey | 90 days from the notice of the disputed claim determination | |
| New Jersey | 18 months from the date the first payment of a claim was made | |
| North Carolina | 2 years from the original claim payment | Participating Provider and Non-Participating Providers |
| Ohio | 2 years | Participating Provider and Non-Participating Providers |
| Oklahoma | 2 years | Participating Provider and Non-Participating Providers |
| Oregon | 18 months from the claim denial | Participating Provider and Non-Participating Providers |
| Rhode Island | 18 months | Participating Provider and Non-Participating Providers |
| Tennessee | 18 months | Participating Provider and Non-Participating Providers |
| Washington | 24 months from the denial date or payment date | Participating Provider and Non-Participating Providers |
| State | Time | Remarks |
| Arizona | 1 year | Participating Provider and Non-Participating Providers |
| California-HMO | 365 days | Participating Provider and Non-Participating Providers |
| California-Traditional | 180 days | Participating Provider and Non-Participating Providers |
| Colorado | 12 months | Participating Provider and Non-Participating Providers |
| Florida | 12 months | Participating Provider and Non-Participating Providers (Note: Does not apply to facility) |
| Georgia | 2 years | Participating Provider and Non-Participating Providers |
| Indiana | 2 years from claim payment date | Participating Provider and Non-Participating Providers |
| Kentucky | 2 years | Only Participating provider |
| Maryland | 365 days | Participating Provider and Non-Participating Providers |
| New Jersey | 90 days from the notice of the disputed claim determination | |
| New Jersey | 18 months from the date the first payment of a claim was made | |
| North Carolina | 2 years from the original claim payment | Participating Provider and Non-Participating Providers |
| Ohio | 2 years | Participating Provider and Non-Participating Providers |
| Oklahoma | 2 years | Participating Provider and Non-Participating Providers |
| Oregon | 18 months from the claim denial | Participating Provider and Non-Participating Providers |
| Rhode Island | 18 months | Participating Provider and Non-Participating Providers |
| Tennessee | 18 months | Participating Provider and Non-Participating Providers |
| Washington | 24 months from the denial date or payment date | Participating Provider and Non-Participating Providers |
Medical Billing Denials and actions – (medicalbillingcycle.com)