Did you know that many healthcare practitioners get confused when it comes to the timely filing limit and appeal filing limit? As if medical billing were not intricate enough on its own, the terminology mix-up further complicates things.
The reason is simple. Timing is not just a metric. It is the difference between revenue and a write-off. While both filing limits represent strict deadlines, they govern entirely different stages of the revenue cycle.
This guide will uncover everything you need to stay ahead, from their differences to key challenges, and filing deadlines of major payers. So, continue reading!
Timely Filing Limit (TFL) for Medical Billing Claims
It can be defined as the maximum allowable time set by the insurance payer for submitting a medical claim after you have rendered a service (i.e., from the date of service). Simply put, it is the claim submission deadline.
Some of the benefits of the timely filing limit in medical billing are listed below:
Prevents Revenue Leakage
When you adhere to the filing limit, it helps you get paid for the care services you provided. In case you miss the deadline, the debt is typically uncollectible. As a result, providers often write off the amount, leading to a strained revenue cycle.
Maintains Contractual Compliance
Adhering to the claim-filing deadline set by the payer is a key requirement for being an in-network provider. If you frequently violate it, it can jeopardize payer contracts.
Accelerates Cash Flow
When you ensure timely claim submissions, it reduces days in accounts receivable and provides a steady cash flow.
Reduces Administrative Burden
Prompt claim filing ensures data and clinical notes are fresh and accessible because older claims are challenging to review and correct.
Enhances Patient Experience
Late billing results in surprise medical bills months or years later, damaging patient trust and increasing patients’ financial responsibility. However, with TFL, you reduce the likelihood of these bad experiences and enhance the overall patient journey.
Improves Data Accuracy
With prompt claim filing, practices can identify and fix systemic coding errors early.
Appeal Filing Limit (AFL) for Medical Billing Claims
It is the time the insurance payer allows during which you can contest a denied or underpaid claim. Simply put, it is a denial reconsideration window.
The following are some of the benefits of the appeal filing limit in medical billing:
Guarantees Revenue Recovery
It provides a guaranteed legal window during which you can fix claim errors, such as missing modifiers, typos, etc. This ultimately helps you to turn a zero-dollar denial into a paid service.
Payer Processing Errors Resolution
AFL facilitates healthcare providers in disputing wrongful denials. These may include denials that occur when a payer’s automated system incorrectly flags a service as not medically necessary.
Protection of Legal Rights
Complying with the appeal filing deadline preserves the provider’s right to escalate the claim to higher levels of appeal.
Operational Accountability
When you have a deadline to meet, it forces you to work on denials proactively. As a result, it also prevents old, unresolved claims from cluttering the accounts receivable reports.
Data-Driven Insights
As you monitor the appeal window, you have a chance to identify specific payers that frequently deny claims. It is a valuable insight that allows you to perform better contract negotiations with the payer.
Prevent Permanent Financial Loss
Once the appeal window closes, the denial becomes final, and there is no way to overturn it. Thus, adhering to the appeal limit ensures that no claim is permanently written off without a fight.
Timely Filing Limit (TFL) vs. Appeal Filing Limit (AFL)
The table below offers an at-a-glance view of the differences between the two filing limits:
| TFL in Medical Billing | AFL in Medical Billing | |
|---|---|---|
| Primary Goal | To submit the original claim for the first time. | To dispute or correct a claim that was already processed/denied. |
| Clock Starts On | The date of service (DOS). | The date on the explanation of benefits (EOB) or remittance advice. |
| Standard Filing Deadline | 1 year for Medicare. For private payers, it typically ranges from 90 to 180 days. | 120 days from the date of the initial determination notice for Medicare. For commercial payers, it may range from 60 to 180 days (often matches the TFL). |
| Required Action | Initial submission of a clean claim. | Submission of a corrected claim or a formal appeal letter. |
| Example | Picture a patient who visits a dermatologist on January 1, 2026.You must send the claim by January 1, 2027 (for Medicare). If you send it on January 2, it will result in a CO-29 denial, which indicates you missed the timely filing deadline. | Assume the same scenario.You submitted the claim on time, but it triggered a ‘missing modifier’ denial on February 1, 2026. It means you have a specific window (e.g., 120 days from February 1) to appeal that specific denial for Medicare. |
The timely filing limit is the claim submission deadline. Contrarily, the appeal filing limit defines the allowable denial reconsideration window set by the payer.
Timely Filing Limit (TFL) of Major Payers
Let’s review the standard timely filing deadlines of major insurance payers:
| Insurance Company | Timely Filing Limit |
|---|---|
| Aetna TFL 2026 | It has a 120-day filing limit. However, for Aetna Better Health and Aetna Health Kids, the limit extends to 180 days from the date of service. |
| Ambetter TFL 2026 | It offers a 120-day filing limit. |
| AvMed TFL 2026 | It allows you to file the claim for up to 1 year after you provide the service. |
| Beacon Health TFL 2026 | You can submit the claim to this payer within 90 days. |
| Blue Cross Blue Shield (BCBS) TFL 2026 | Varies from 90 days to up to 2 years, depending upon the state. |
| Buckeye TFL 2026 | Up to 1 year is the claim filing limit for this payer. |
| Caresource TFL 2026 | It has a 90-day filing limit. |
| Cenpatico TFL 2026 | It accepts claims for up to 90 days after the service was rendered. |
| Champus (Tricare) TFL 2026 | You have up to 1 year to submit a claim. |
| Cigna TFL 2026 | Primarily, it offers a 90-day filing limit. However, for Cigna (out-of-network) providers, the deadline extends to 180 days. |
| Emblem Health TFL 2026 | It has a 120-day filing deadline. |
| Fidelis New York TFL 2026 | You can submit a medical claim within 90 days after rendering the service. |
| GEHA TFL 2026 | This payer offers a 90-day filing limit. |
| Harvard Pilgrim Health Care TFL 2026 | The filing deadline for this insurance payer is 90 days. |
| Humana TFL 2026 | You have up to 90 days to submit a medical claim. |
| Kaiser Permanente TFL 2026 | It offers a 180-day filing deadline. |
| Magellan TFL 2026 | It has a 60-day filing limit. |
| McLaren Health Plan TFL 2026 | Up to 1 year is the claim filing deadline for this payer. |
| Medical Mutual TFL 2026 | You can submit the claim to this payer within 1 year of rendering the service. |
| Medicare TFL 2026 | It accepts claims for up to 1 year after the service was performed. |
| Medicaid TFL 2026 | Typically, it offers a 180-day claim-filing limit. However, TFLs may vary by state. |
| Meridian TFL 2026 | You have up to 1 year to submit a medical claim. |
| United Healthcare TFL 2026 | It has a 90-day filing limit. |
2026 Timely Filing Limit in Different States
The filing deadlines we discussed in the previous table were standard. However, they significantly vary from state to state, specifically for Medicaid and its several managed care organizations (MCOs) operating in different states, e.g., BCBS.
Here’s a table offering a glimpse into Medicaid’s state-specific timely filing deadlines:
| State Name | Timely Filing Limit 2026 |
|---|---|
| Alabama | Up to 1 year. |
| Alaska | It offers a 1-year filing deadline. |
| Arizona | This state has a 180-day filing deadline. |
| California | In this state, you can submit a claim within 180 days after rendering service. |
| Florida | It allows a 1-year filing limit. |
| Georgia | Up to 180 days. |
| Illinois | You can submit a medical claim within 180 days after rendering the service. |
| Indiana | You have up to 1 year to submit a claim. |
| Iowa | Up to 1 year is the claim-filing limit for this state. |
| Kentucky | The filing deadline for this state is 1 year. |
| Louisiana | For this state, claims are accepted up to 1 year after the service was performed. |
| Maryland | It offers a 1-year filing limit. |
| Michigan | Up to 1 year. |
| Mississippi | This state has a 180-day filing deadline. |
| New York | You have up to 90 days to submit a medical claim. |
| North Carolina | It allows a 1-year filing limit. |
| Ohio | The filing deadline for this state is 1 year. |
| Oklahoma | This state accepts claims for up to 1 year after the date of service. |
| Pennsylvania | Up to 180 days. |
| Tennessee | It has a 1-year filing deadline. |
| Texas | It offers a 95-day filing limit. |
| Virginia | For this state, the filing deadline is 1 year. |
| Washington | It allows a 1-year filing limit. |
| Wisconsin | The claim filing deadline is up to 1 year. |
Appeal Filing Limit of Major Payers
The table below shows the appeal deadlines of major insurance payers:
| Insurance Company | Appeal Filing Limit 2026 |
|---|---|
| Aetna | It has a 180-day dispute filing limit. |
| Ambetter | This payer offers a 90-day deadline from the original explanation of payment (EOP). Besides, you get another 90 days for a second-level appeal from the appeal denial notice. |
| AvMed | You get 60 calendar days after the date of the remittance advice. |
| BCBS | Varies from 60 days to up to a year, depending on the state. |
| Beacon Health | You can contest denials or underpayments within 1 year. |
| Buckeye | It provides a 65-day appeal deadline. |
| Caresource | The filing limit for submitting claim appeals for this payer is 90 calendar days. |
| Cenpatico | You get 90 days to appeal from the denial date. |
| Champus (Tricare) | Up to 90 days. |
| Cigna | Submit the appeal within 180 calendar days. |
| Emblem Health | You can appeal within 180 days. |
| Fidelis New York | It allows a 60-day filing limit for submitting reconsideration requests. |
| GEHA | This payer offers a 180-day appeal filing deadline. |
| Harvard Pilgrim Health Care | You can file an appeal request within 180 days. |
| Humana | It has a 65-day appeal-filing deadline. |
| Kaiser Permanente | You can submit an appeal within 60 calendar days from the statement of remittance. |
| Magellan | With this insurance payer, you get up to 180 days to file an appeal. |
| McLaren Health Plan | It offers a 90-day time frame for submitting an appeal request. |
| Medical Mutual | This payer has a 180-day appeal deadline. |
| Medicare | You have 120 days from the date of receipt of the initial claim determination to file an appeal. |
| Medicaid | Anywhere between 60 days and 2 years, depending on the state. |
| Meridian | You can submit an appeal request within 120 days of the EOP. |
| United Healthcare | You must file your appeal within 65 days. |
2026 Appeal Filing Limit in Different States
Similar to timely filing deadlines, appeal filing deadlines also vary across states for Medicaid and its MCOs. Here’s a list of Medicaid’s appeal filing limits in different states:
| State Name | Appeal Filing Limit 2026 |
|---|---|
| Alabama | You have 180 days post-denial. |
| Alaska | It offers a 180-day deadline to appeal the denial or underpayment. |
| Arizona | This state has a 1-year appeal deadline. |
| California | In this state, you can resubmit the corrected claim or appeal within 60 days. |
| Florida | In this state, the allowable time limit for adjustments and appeals is 180 days. |
| Georgia | You can appeal denials or resubmit the corrected claim within a year. |
| Illinois | For this state, the appeal-filing deadline is 180 days. |
| Indiana | You get up to 90 days to contest a denial in this state. |
| Iowa | It offers up to 180 days to file an appeal. |
| Kentucky | You can resubmit or appeal within 120 days from the date of denial. |
| Louisiana | For this state, it accepts appeals for up to 2 years after the denial. |
| Maryland | The appeal deadline extends to 180 days. |
| Michigan | Up to 120 days. |
| Mississippi | The appeal filing deadline for this state is 180 days. |
| New York | You have 60 days post-denial. |
| North Carolina | The payer accepts resubmission and appeals within 180 days. |
| Ohio | It provides a 180-day appeal deadline. |
| Oklahoma | This state has a 180-day appeal deadline. |
| Pennsylvania | You can contest the denial or underpayment within 60 days. |
| Tennessee | It offers a 180-day deadline to appeal the denial or underpayment. |
| Texas | For this state, the appeal filing deadline is 120 days. |
| Virginia | In this state, you can resubmit the corrected claim or appeal within 180 days. |
| Washington | The appeal filing deadline extends to 2 years in this state. |
| Wisconsin | In this state, the allowable time limit for adjustments and appeals is 180 days. |
Challenges of TFL & AFL in Medical Billing
Let’s review some of the key challenges healthcare providers experience when it comes to filing limits:
Coordination of Benefits (COB) Delays
Do you know what happens when a patient has primary and secondary insurance? You cannot transfer the claim to the secondary payer until the primary payer has finished processing it.
The Consequence? If the primary payers take 8 months to pay, the TFL for the secondary payer may be near the deadline.
The Solution: You must move with extreme speed as soon as the primary EOB arrives to prevent a CO-29 denial from the secondary insurance payer.
The Clock Trigger Confusion
The date when the filing limit starts changes depending on whether you are submitting the claim initially or appealing a denial.
The Challenge? Healthcare providers often confuse the two dates, especially when handling corrected claims. The reason? Insurance payers sometimes treat resubmissions as initial submissions and other times as appeals.
Best Practice: Always communicate with the relevant payer to understand their specific policies. Besides, remember the following by heart:
- TFL: Clock starts on the date of service.
- AFL: Clock starts on the date of receiving an EOB/remittance advice.
Shadow Deadlines in MCOs
Oftentimes, healthcare providers assume that if they are billing a reputable payer like BCBS or Cigna, they must have a standard 180-day appeal window.
The Consequence? If a patient has a Managed Medicaid or Medicare Advantage plan through that payer, the limit may shrink to as low as 60 days. As a result, practices miss the golden opportunity to recover lost revenue.
The Solution: Always check the relevant insurance plan and state-specific, timely filing and appeal filing limits.
Conclusion
Phew! That is quite a detailed guide, but it serves the purpose, i.e., a handy resource with everything you need to know about the timely filing limit and appeal filing limit.
Hopefully, with this guide as a go-to resource, you will never miss a filing deadline. However, if you are struggling with a high denial rate and want professional help, feel free to acquire denial management services from MediBillMD.
