Timely Filing Limit of Insurances
Timely Filing Limit (TFL) refers to the specific timeframe within which healthcare providers or medical billing companies must submit claims to insurance carriers for reimbursement. The TFL is crucial because if a claim is not submitted within this designated time period, the insurance company has the right to deny the claim, resulting in potential financial loss for the provider.
| Insurance Names | Claims Timely Filing Limit – TFL |
|---|---|
| Aetna timely filing limit | Aetna timely filing limit list for claims |
| Aetna Better Health timely filing limit | Aetna Better Health timely filing limit |
| Aetna Better Health Kids timely filing limit | Aetna Better-health-kids timely filing limit |
| Ambetter timely filing limit | 180 days from the date of service |
| Amerigroup timely filing limit | 90 days from date of service Corrected/Appeal claims: 60 days from the denial or payment date |
| American life and health timely filing limit | 1 year from date of service |
| AARP timely filing limit | 15 months from the date of service |
| Bankers Life timely filing limit | 15months from the date of service |
| BCBS Timely filing limit | BCBS Timely Filing limit list – Anthem State-wise (medicalbillingcycle.com) |
| Cigna Timely filing limit | 90 days from date of service(Participating Providers) 180 days from date of service(Non Participating providers) Corrected/Appeal: 180 days from the denial or payment date |
| Coventry Timely filing limit | 180 days from the date of service |
| Emblem Health Timely filing limit | 120 days from date of servcie |
| GHI Timely-filing-limit | One year from date-of-service(Participating-providers) Eighteen months from the date-of-service(Non-Participaitng- provider) Secondary Claims: 365 Days from the primary EOB date |
| Healthsprings Timely filing limit | 120 days from date of servcie Corrected/Appeal: 180 days from the denial or payment date |
| Healthfirst Timely filing limit | 1 year from date of service |
| Humana Timely filing limit | 90 days from the service date(Commercial) |
| Humana Medicare Timely filing limit | 1 year from the date service rendered(Medicare Advantage) |
| Humana Caresource Timely filing limit | 365 days from the service date |
| Humana Military timely filing limit | 1 year from the service date |
| Kaiser Permanente Timely filing limit | 90 days from the date of service |
| Keystone Timely filing limit | 180 days from the date of service CorrectedClaims: 365-days from the Denial-date |
| Medicare Timely filing limit | 12 months from the date of service Appeal: 120 days from the denial date |
| Medicaid Timely filing limit | 12 months from the service-date |
| Molina Healthcare Timely filing limit | One-Calendar year from the DOS Secondaryclaims: 180days from the primary-EOB-processing-date |
| Mutual of Omaha Timely filing limit | 1 year from the date of service |
| Nationwide Health Timely filing limit | 15 months from the date of service |
| Operators Engineers Timely filing limit | 1 year from the date of service |
| Tricare Timely filing limit | 1 year from the date of service(Non network provider) 90 days from the date of service(Participating provider) When tricare is secondary then 90 days from the primary paid or denied date. |
| United Health care Timely filing limit | Par-provider: Ninety days from DOS Non-Par-Provider – 120days from DOS Secondaryclaims: 90days from the primary EOB date Corrected claims: 120 days from initial payment Appeal: 1 year from date of original denial or payment |
| Wellcare Timely filing limit | 180 days from the date of service (Medicare) |
What is timely filing limit?
Timely filing limit typically refers to the deadline set by insurance companies for healthcare providers to submit claims for reimbursement of medical services rendered to patients. This limit is crucial as it ensures that claims are submitted promptly, reducing the risk of errors, delays, and loss of revenue for both providers and insurers.
The TFL can vary depending on the insurance company and the type of insurance plan. Generally, the standard timeframe for timely filing is around 90 days from the date of service, but it is essential for providers to verify the exact deadline with each individual insurance carrier to avoid claim denials.
Healthcare providers should establish efficient billing processes and systems to meet timely filing deadlines consistently. This includes proper documentation, accurate coding, and quick submission of claims to avoid potential issues with reimbursement.
Failure to comply with timely filing limits can have a significant impact on a provider’s revenue cycle and create administrative challenges. It is essential for healthcare organizations to stay informed about the timely filing requirements of each insurance carrier they work with and allocate resources to ensure timely and accurate claims submissions.
Example:
Understanding the timely filing limits for insurance claims is crucial for healthcare providers to ensure reimbursement. Each insurance company, such as Humana, has specific rules regarding when claims must be submitted. For instance, Humana Medicare Advantage requires claims to be filed within 1 year from the date of service, with appeals to be submitted within 60 days of an adverse benefit determination. On the other hand, Humana Commercial claims must be submitted within 90 days of the service provided. Providers dealing with Humana CareSource have a 365-day timely filing limit from the date of service, and the same timeframe applies for submitting corrected claims or appeals. For Humana Military, claims must also be submitted within 1 year from the date of service. By understanding and adhering to these timely filing limits, healthcare providers can optimize their revenue cycle management and avoid claim denials. In conclusion, understanding and adhering to timely filing limits is crucial for healthcare providers to maximize revenue, maintain positive relationships with insurance companies, and streamline the reimbursement process for medical services provided to patients.