Medicare claims must be filed to the MAC no later than 12 months, or 1 calendar year, from the date the services were furnished. This includes resubmitting corrected claims that were unprocessable.
Use the Claims Timely Filing Calculator (JH) (JL) to determine the timely filing limit for your service.
Example: Patient seen on 06/20/2026, file claim by 06/20/2027.
To determine the 12-month timely filing period/claims filing deadline, we use the “From” date on the claim.
Some examples of reject and denial codes you may receive for timely filing include:
Part A: Reject reason code 39011
Part B: CO 29
Situations may occur when complete or accurate insurance information is not obtained from the patient. However, this does not change Medicare’s timely filing requirements.
Always request and review all insurance cards at the time of service.
Ask the patient if they are entitled to Medicare and whether Medicare is primary or secondary.
Lack of awareness (e.g., not knowing the patient has Medicare or that Medicare is primary) is not a valid reason to waive timely filing requirements.
If the patient indicates Medicare is secondary, submit the claim to the primary insurer first.
After receiving the primary insurer’s remittance, submit the claim to Medicare as secondary—even if no payment is expected.
If a claim was initially submitted incorrectly and the primary payer later recoups payment, you may adjust the Medicare Secondary Payer (MSP) claim accordingly.
Discovering after the fact that Medicare is primary does not justify a timely filing waiver.
MSP and tertiary payer scenarios do not extend or alter Medicare’s timely filing deadlines.
There are no appeal rights for claims denied due to untimely filing.
Exceptions to the 12-month timely filing period are limited and very specific as outlined in the CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 1, Section 70.7
Loading...
