Timely filing limits do not care about the holidays. A commercial claim with a 90-day limit from a September 10 date of service is dead on December 9. A payer with a 180-day limit closes on every May date of service during November. And Medicare's twelve-month limit means anything from last November and December is expiring right now, in the same weeks the billing team is short-staffed and the front desk is drowning in benefit questions.
We run a timely filing sweep every November for the practices we support and we recommend every in-house team does the same. It is not glamorous work. It is a list, a set of deadlines, and two weeks of focused effort that routinely turns up money that was about to disappear for good. It also produces the one number that convinces a practice owner to fund a daily rejection review: the dollars written off to timely filing this year.
Key takeaways
- Age-based AR reports hide filing risk; sort every unresolved encounter by days remaining until its payer's limit instead.
- Pull four lists: encounters with no claim, rejections never accepted, claims with no response, and denials with no action.
- Work soonest deadline first, not largest balance first, with a daily minimum per person.
- A claim past the limit can often be saved if you can prove original timely submission with a clearinghouse acceptance report.
- Write off what is truly lost with a specific timely filing adjustment code, and use the total to justify next year's prevention.
Why age-based AR reports hide the problem
The standard aging report groups claims into 0 to 30, 31 to 60, 61 to 90, 91 to 120 and over 120 days. That is useful for measuring collection speed and useless for timely filing, because a claim in the 61 to 90 bucket may have 5 days left with one payer and 275 days left with another. The sweep needs a different sort: days remaining until the filing limit, by payer, for every encounter that does not yet have an accepted claim or a final adjudication.
Build a simple table of your payers and their limits. Most practice management systems let you store a filing limit per payer; if yours does, this is the month to populate it. If not, a spreadsheet works. Note the trigger date for each payer too: most count from the date of service, but some count from the discharge date for facility claims, and the corrected-claim and appeal windows count from the remittance date.
| Payer type | Typical initial filing limit | Typical limit for corrected claims or appeals |
|---|---|---|
| Medicare Part B | 12 months from date of service | 120 days from the remittance date for a redetermination |
| Medicaid (varies by state) | Commonly 90 days to 12 months | State specific; often 60 to 90 days |
| Large commercial payers | 90 to 180 days, set by contract | Often 60 to 180 days from the denial |
| Medicare Advantage plans | Set by contract; frequently 90 to 365 days | Plan specific |
| Workers' compensation and auto | State specific | State specific |
These are typical ranges, not rules. Your contract is the only number that counts, which is one more reason to keep the payer contract summary we described in the contract review article current. When a payer's limit is not in the contract, it is usually in the provider manual, and the manual can change with notice; check the current version, not the one you printed in 2022.
The four lists to pull
Run each of these for dates of service in the last 15 months and sort by payer, then by date of service ascending.
- Encounters with no claim. Signed encounters that never produced a claim: charges in a hold queue, encounters awaiting coding, visits where the charge was never entered. These are the most urgent because nothing has been sent and no proof of timely filing exists.
- Clearinghouse rejections with no later acceptance. A rejected claim never reached the payer, so the clock is still running from the date of service. Sort these by rejection reason as well; a batch of subscriber ID rejections from one payer usually has one cause.
- Claims with no response. Submitted, accepted by the clearinghouse, no remittance and no payer acknowledgment after 45 days. Some of these were never received. Check claim status through the portal before assuming they are in process.
- Denials with no follow-up action. Denials that were posted and never corrected, appealed or deliberately written off. Sort by dollar amount, then by appeal deadline.
Combine the four lists into one sheet with a common set of columns: patient account, date of service, payer, billed amount, list source, days remaining, owner and status. The combined sheet is the sweep. Everything else is preparation.
Work the lists by deadline, not by dollar
The natural instinct is to chase the biggest balances first. In a timely filing sweep the right order is soonest deadline first, because a $60 claim that expires Friday is worth more than a $900 claim with 200 days left. Assign each line a "days remaining" value, sort the whole combined list on it, and work from the top. Set a daily minimum (a number of lines cleared per person per day) and track it on a whiteboard or a shared sheet. In our experience a small team clears a surprising amount in ten working days when the list is sorted this way.
One refinement: split the sheet at 30 days remaining. Everything under 30 days is worked this week by whoever is available, including the billing manager. Everything over 30 days is assigned by payer to the person who normally works that payer, with a due date two weeks before the limit. The split keeps the urgent work from being buried under the merely important work.
A worked example
A five-provider practice we will describe in round numbers ran the four lists in the first week of November. The combined sheet had 412 lines totalling $118,000 in billed charges. Sorted by days remaining: 61 lines ($14,200) had fewer than 30 days left, 140 lines ($47,800) had 30 to 90 days, and the rest had more than 90 days, mostly Medicare claims with months to run. Of the 61 urgent lines, 38 were clearinghouse rejections from one commercial payer, all with the same subscriber ID format error dating from a payer system change in August. Fixing the format rule and resubmitting cleared 38 lines in one afternoon. Eleven were hold-queue encounters missing a diagnosis code; the coder cleared them in a morning. Nine were no-response claims that the portal showed as never received; they were resubmitted with the original acceptance reports attached. Three were past the limit with no proof and were written off, about $600.
The urgent bucket took two people three days. The 30-to-90-day bucket took the regular team two weeks alongside their normal work. The practice recovered a large share of the $62,000 in the first two buckets, and the $600 write-off, plus roughly $9,000 written off earlier in the year for the same reason, became the case for a daily rejection review starting in January. The figures are illustrative; the shape is what we see almost every year.
The claims you can still save after the limit
A claim past the filing limit is not automatically lost. Most payers accept a timely filing appeal if you can prove the claim was originally submitted on time, and the proof they accept is a clearinghouse acceptance report (the 999 or 277CA) showing the original submission date and the payer's receipt. This is why rejected claims are so dangerous: a rejection is proof the claim was not accepted, and payers know it. Save your acceptance reports, and keep them retrievable by claim.
Other situations that support an appeal, depending on the payer: the patient gave you the wrong insurance and you billed another payer in good faith within the limit (attach the other payer's denial); the payer's own eligibility response was wrong (attach the 271 response); a retroactive Medicaid eligibility determination (attach the eligibility letter); or a payer system outage the payer acknowledged (attach the bulletin). Each requires documentation. Write the appeal in plain language, attach the proof, quote the payer's own timely filing policy, and send it by the method the contract specifies. Medicare has its own list of acceptable exceptions to the twelve-month limit, including retroactive Medicare entitlement and certain administrative errors, and they are narrow; do not assume a general hardship argument will work.
Write off what is lost, on purpose
Claims that are truly beyond the limit with no proof of original submission should be written off with a specific adjustment code that says timely filing, a note with the payer and the date, and a name. Do not let them sit in AR making the aging report look worse and do not bury them under a generic write-off code. The timely filing write-off total for the year is one of the most honest numbers a billing department produces, and it is the number that justifies fixing the process upstream. A practice that wrote off $14,000 to timely filing this year has a $14,000 argument for a daily rejection review next year.
The sweep finds the failures; it does not fix them. When it is done, take the rejection reasons, the hold queue reasons and the no-response payers and turn each into a weekly check with an owner. We wrote about the reconciliation habits that prevent most of it in why completed encounters never become claims. The practices that run those every week have a very short sweep list in November. The ones that don't have a very long one.
Questions we hear
Can we bill the patient for a claim we missed the filing limit on?
Almost never for a contracted payer. Participation agreements and Medicare rules generally prohibit billing the patient for amounts the payer denied because the provider filed late. Treat these as practice write-offs.
How far back should the sweep go?
Fifteen months covers Medicare's twelve-month limit with a margin for the redetermination window. If you have payers with longer contractual limits, extend the window to match.
Is this something an outside team can do quickly?
Yes, and it is one of the more common projects we take on in the fourth quarter. A revenue leakage audit sizes the exposure first so you know whether the sweep is a two-day job or a two-week one.
What to do this week
- Populate the filing limit for every payer in the PM system or a spreadsheet, with the trigger date for each.
- Run the four lists for the last 15 months and combine them into one sheet with a days-remaining column.
- Split the sheet at 30 days remaining; assign the urgent lines to everyone available, the rest by payer with due dates.
- Locate your clearinghouse acceptance reports and confirm you can retrieve one by claim number in under five minutes.
- Set up a timely filing adjustment code, if you do not have one, and start using it for every deliberate write-off.
