> ## Documentation Index
> Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Timely filing limits by payer
> Why dental timely filing is contract-specific, how to record each limit, the few deadlines fixed by regulation, and evidence that supports a CARC 29 appeal.
**Timely filing** is the deadline by which a claim must reach the payer. A late claim is generally unpayable and may return CARC 29 even when the clinical and coding information is correct.
Payer portals, forms, IDs, and procedures change frequently. **Timely-filing limits and other participation terms come from the applicable current payer materials and your executed agreement.** Use this page as a starting point, then verify the product, entity, provider, location, and effective date with the payer.
## Why there is no universal table
Dental timely filing limits are **contractual**. They vary by carrier, product line, state, and negotiated agreement, so two practices can have different limits with the same payer. Three sources of variation deserve particular attention:
* **Per contract.** Each PC's participation agreement with each carrier sets its own limit. A DSO with ten PCs has ten sets of limits, not one.
* **Per Delta member company.** There is no national Delta number. Each of the 39 member companies sets timely filing in its own participation agreement and dentist handbook, so a multi-state group has a different Delta limit per state.
* **Per DBA provider manual.** Medicaid dental limits live in each dental benefit administrator's provider manual for each state program, and change at reprocurement.
A static "carrier X = N days" table would be inaccurate for some readers. **Record each limit from the executed contract or current provider manual** in the enrollment grid when signing.
## The limits that can be stated
| Payer | Initial filing limit | Basis |
| --------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------- | --------------------------------------------------------------------------- |
| **Medicare fee-for-service** (crossover work only) | **12 months from the date of service** | Statutory and regulatory1; one of the few genuinely fixed limits |
| **Medicare Advantage dental** | Set by the plan's contract, **not** Medicare's 12 months; frequently far shorter | Plan contract |
| **Medicaid FFS** | State-specific; commonly 90 days to 12 months | State regulation |
| **Medicaid DBAs** (DentaQuest, MCNA, Liberty, others) | Per the provider manual for that state program | Contract / manual |
| **TRICARE dental** | Set by program rules; confirm with United Concordia | Program |
| **Delta Dental member companies** | Per member company. Consult each participation agreement | Contract |
| **Commercial dental carriers** (MetLife, Cigna, Aetna, Guardian, UHC, Humana, Ameritas, United Concordia) | Consult the contract and provider manual | Contract |
| **Secondary / COB claims** | Often measured from the **primary's remittance date**, not the service date | Contract |
**Medicare Advantage plans are not bound by Medicare's 12-month limit.** Confirm the plan's contractual deadline instead of applying the fee-for-service rule.
## The three windows to record
Each payer has **three** deadlines, and they differ:
| Window | What it governs | Typical relationship |
| ------------------- | ------------------------------------ | ------------------------------------------------------- |
| **Initial filing** | Original claim submission | The longest |
| **Corrected claim** | Resubmitting a claim with fixed data | Often **shorter** than initial |
| **Appeal** | Contesting an adjudication | Runs from the **remittance date**, not the service date |
Record all three per payer when you sign the contract.
## Proving you filed on time
**Clearinghouse acceptance reports are the standard evidence.** A 277CA showing payer acceptance on a specific date, or a clearinghouse transmission report, can support a CARC 29 appeal.
A PMS screenshot showing "submitted" does not establish that the payer received the claim.
Retain acceptance reports for at least the longest appeal window across your payer mix.
## The exceptions
| Exception | Basis |
| ---------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------- |
| **Proof of timely submission** | The claim was filed on time; the payer lost or misprocessed it. Strongest argument. |
| **Retroactive eligibility** | Coverage backdated after service; the clock generally runs from when eligibility was established. Common in Medicaid. |
| **Coordination of benefits delay** | The secondary's clock typically runs from the primary's remittance |
| **Payer error** | The claim was rejected in error and promptly resubmitted |
| **Provider enrollment delay** | Where a retro-effective date was granted, ask how the payer measures filing from it |
| **Catastrophic circumstances** | Disaster or systems outage. The **2024 Change Healthcare outage** produced widespread accommodations, a useful precedent if it recurs. |
Each has a documentation requirement. Assemble it with the appeal.
## Controls for preventing timely-filing write-offs
The clock starts at the date of service.
A claim stuck in a rejection loop is a common cause of timely-filing loss. A 277CA rejection means the payer did not accept the claim into adjudication even if the PMS shows it as "submitted." A rejected claim sitting for two months has consumed two months of a 90-day window.
Review every claim submitted more than three days ago with no 277CA acceptance. This can identify claims that did not move successfully from the PMS to the payer.
Claims held during credentialing, awaiting a required preauthorization, waiting on attachments, or pending COB need an aging report with the deadline attached.
If the limit is 90 days, escalate anything unfiled at 45. The buffer absorbs the rejection loop.
Weekly, by payer.
Any non-zero number gets a root cause and a process change.
## The grid template
| Field |
| -------------------------------------------------------------------- |
| Entity |
| Payer, and product line (for Delta: the member company) |
| **Initial filing limit** |
| **Corrected claim window** |
| **Appeal window** (and from what date it runs) |
| Contract effective date |
| Where the limit is stated (contract section or provider-manual page) |
| Date recorded / verified |
Verify annually and on every contract renewal or amendment; unilateral amendment clauses mean a limit can change without your signature. See [Beat timely filing](/guides/billing/beat-timely-filing) for the operating workflow.
## Sources
1. Medicare timely filing: Social Security Act § 1842(b)(3)(B); 42 C.F.R. § 424.44. See CMS, [Medicare Claims Processing Manual](https://www.cms.gov/regulations-and-guidance/guidance/manuals/internet-only-manuals-ioms-items/cms018912), ch. 1. Relevant to dental groups only for crossover billing. See [Medicare and dental](/reference/payers/profiles/medicare-and-dental).