Almost everything in insurance billing is fixable. A wrong code, a missing modifier, a denied claim, a rate you did not know you had agreed to. All of it can be corrected, appealed, or renegotiated.
Timely filing is the exception.
Every payer sets a deadline for submitting a claim, measured from the date of service. Miss it and the money is not late. It is gone. There is nothing to appeal, because the deadline is the whole rule.
This is the shortest post on this blog, because the thing itself is short. You need one number per payer and a system that makes it impossible to miss.
The number varies more than you would guess
There is no standard. Windows range from roughly ninety days to a full year depending on the payer and sometimes depending on the specific plan within that payer.
Medicare is generally a year from the date of service. Many commercial plans are considerably shorter. Some Medicaid managed care plans are shorter still, and a secondary claim often has its own clock that starts when the primary payer's remittance is issued, not when you saw the client.
Do not rely on a number you read in a forum, and do not assume the payer you know best is representative. Find yours, per payer, and write it down.
Where to find it
Three places, in order of reliability.
Your contract or the provider manual. The manual is usually a PDF in the provider portal and it is where the real answer lives. Search it for "timely filing" or "claim submission."
The provider portal itself. Often has a billing or claims FAQ with the window stated plainly.
Provider relations, in writing. If the first two fail, email and ask for the timely filing limit for your contracted plans. Ask in writing so you have the answer on paper.
The one page that prevents all of this
Make a single table. Six columns, one row per payer:
Payer · timely filing window · appeal window · telehealth modifier · place of service code · date you last verified
Keep it wherever you actually look, not in a folder you will forget. Review it once a year, and any time a claim is denied for a reason you do not recognise.
That page is the whole defence. It takes an afternoon to build and it never needs to be built again.
The second clock
There is a second deadline running alongside the first, and it is the one that catches experienced people.
The appeal window is how long you have to dispute a decision after the payer has made it. It usually runs from the date on the remittance advice rather than the day you happened to look. It is often shorter than the filing window.
On day one, a coding error is a nuisance you fix in ten minutes. Further down the line, the identical error is an unrecoverable loss. Nothing about the error changed. Only how long it sat there with nobody looking at it.
Which is why the fix for both clocks is the same thing.
A weekly hour beats vigilance
You will be careful in month one, when insurance is new and slightly frightening. In month seven, with a full caseload and a week that got away from you, you will not be. There is nothing wrong with you for that.
Vigilance loses to a busy week every time. A rhythm on your calendar does not care what kind of week you are having.
One hour, same day, every week. Open the remittances, check what was paid against what was allowed, send the claims that have not gone out, and look at anything sitting unresolved. A claim that gets looked at every seven days cannot quietly age past a deadline.
That is the entire system. It is not clever and it does not need to be.
If you have already missed one
It happens, and it has happened to people far more organised than either of us.
Two things are worth trying, both quickly. Some payers will consider a timely filing appeal if you can document that the claim was submitted on time and rejected for an unrelated reason, or that the delay was caused by the payer, for example a coordination of benefits issue or an eligibility error on their side. Proof of timely submission is the whole argument, which is another reason to keep clearinghouse acknowledgements.
If there is genuinely no route, write the loss down in your log with the payer and the reason, and move on to the system that stops the next one. Sitting with it does not recover the money.
Do this today
Pick your three biggest payers. Find the timely filing window for each. Write them on one page.
Twenty minutes, and it is the cheapest insurance you will buy this year.
Start here, free. The Credentialing Timeline lays out every stage of getting paneled with the honest day counts. Get it free at craftyourpractice.com/start
Go deeper. Get Paid is the full course on the insurance side of practice, from clean claim through appeal. See the course
The one guide for this. The Insurance Billing Guide covers clean claims, the weekly rhythm, and the deadlines that decide whether a mistake is fixable. $37, one payment, yours forever. Open it in The Practice Library