Timely Filing Limits by Payer, 2026

How long each payer gives you to file a claim, read from the payer's own current document. Your contract can set a different limit, and it wins.

Checked 10/22/2026. We list a payer only after reading its current manual.

Medicare (Original Medicare, Part A and B)

All states

Initial claim 12 months (1 calendar year) after the date of service Clock starts: Date of service Redetermination (first appeal): 120 days from receiving the initial determination

Source CMS Medicare Claims Processing Manual, Chapter 1, section 70 Chapter revision issued 04/10/2026

Medicare Advantage plans

All plans

Initial claim Set by each plan in its provider contract or manual (no single federal number) Clock starts: Per plan

Source 42 CFR 422.520 (plan payment deadlines) Current text

Texas Medicaid (TMHP)

Fee-for-service claims to TMHP (managed care plans publish their own)

Initial claim 95 days from each date of service (inpatient: from discharge); out-of-state providers 365 days Clock starts: Date of service or discharge Appeals and adjustments: 120 days from the date of disposition

Source Texas Medicaid Provider Procedures Manual, Vol. 1, Section 6 (6.1.4) October 2026 edition

UnitedHealthcare

Commercial, Individual Exchange and Medicare Advantage

Initial claim Set by your participation agreement or state law (no default number in the guide) Clock starts: Date of service or discharge Corrected claims: same limit as the original claim

Source 2026 UnitedHealthcare Care Provider Administrative Guide Effective 04/01/2026

Cigna Healthcare

Commercial

Initial claim In network: 90 days after the date of service. Out of network: 180 days Clock starts: Date of service (last date for consecutive-day services) Appeals: 180 calendar days from the payment or denial notice

Source Cigna Healthcare: Claims submission, payments and filing Page current 2026

Humana

Medicare Advantage (non-delegated providers)

Initial claim 1 year from the date of service, unless your agreement or law says otherwise Clock starts: Date of service

Source Humana 2026 Provider Manual (Non-Delegated), Claims Submission 2026 edition

Blue Cross and Blue Shield of Texas

PPO products

Initial claim 365 days from the date of service Clock starts: Date of service (institutional: through date) First claim review: 180 days from the payment or summary date

Source BCBSTX PPO Provider Manual, Section F(a) Updated 12/19/2025

Blue Cross and Blue Shield of Texas

HMO and EPO products

Initial claim 180 days from the date of service Clock starts: Date of service (institutional: through date)

Source BCBSTX HMO Provider Manual, Section F(a) Updated 12/16/2025

Kaiser Permanente (California)

Northern and Southern California

Initial claim 90 calendar days after the date of service or discharge, unless your agreement or law says otherwise Clock starts: Date of service or discharge Provider disputes: 365 calendar days from the action disputed

Source Kaiser Permanente: Claims Settlement Practices and Provider Dispute Resolution Effective 11/01/2025

Ambetter (Illinois)

Marketplace plans

Initial claim In network: 180 calendar days. Out of network: 90 calendar days Clock starts: As stated in the guide Disputes and appeals: 180 days in network, 90 out of network, from the EOP date

Source Ambetter of Illinois: Claims, Disputes and Recovery Guide Last updated June 2025

Ambetter (North Carolina)

Marketplace plans

Initial claim In and out of network: 180 calendar days Clock starts: As stated in the guide Disputes and appeals: 180 days from the EOP date

Source Ambetter of North Carolina: Claims, Disputes and Recovery Guide Last updated October 2025

TRICARE East

East Region

Initial claim No later than one year after the date of service Clock starts: Date of service

Source Humana Military: Timely filing waiver Current form

XEHR warns you before a claim crosses its limit

Each practice sets its payers' limits once, and XEHR shows which unpaid claims are getting close, in time to file.

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Timely Filing Limits by Payer, 2026

Medicare (Original Medicare, Part A and B)

Medicare Advantage plans

Texas Medicaid (TMHP)

UnitedHealthcare

Cigna Healthcare

Humana

Blue Cross and Blue Shield of Texas

Blue Cross and Blue Shield of Texas

Kaiser Permanente (California)

Ambetter (Illinois)

Ambetter (North Carolina)

TRICARE East

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