March 23, 2012 - Revised: 12.11.23
Medicare Timely Filing Guidelines
The Centers for Medicare & Medicaid Services (CMS) fact sheet advise that the timely filing period for both paper and electronic Medicare claims is 12 months, or one calendar year, after the date of service. Claims are denied if they arrive after the deadline date. When a claim is denied for having been filed after the timely filing period, such a denial does not constitute an initial determination. As such, the determination that a claim was not filed timely is not subject to appeal.
Medicare regulations allow exceptions to the 12-month time limit for filing claims. The exceptions, allowing extensions of the timely filing provisions, include:
- Administrative Error,
- Retroactive Medicare Entitlement,
- Retroactive Medicare Entitlement Involving State Medicaid Agencies and
- Retroactive Disenrollment from a Medicare Advantage (MA) Plan or Program of All-inclusive Care of the Elderly (PACE) Provider Organization.
For more information regarding the Medicare Timely Filing Guidelines and related exceptions please visit: Medicare Claims Processing Manual (cms.gov) section 70 – 70.7.4.