1. NPM Knowledge Base
  2. Medical billing in dentistry

How long do you have to file a medical claim?

Length of time to file medical claims

How long do you have to file a medical claim after services are rendered to a patient? This will vary from insurer to insurer.

The time frame that a practice has to file a medical claim after the date of service of the treatment/procedure is referred to as "timely filing requirements". The standard "rule of thumb" time frame seems to be between 6-12 months after the date of the service.

However, keep in mind - best practice is to always submit your medical claim as soon as possible after the services are rendered. The same day or the next day is always best (which is easy to do using the DentalWriter 4 Step process!)

The Medicare claims processing manual states:
 
"Medicare regulations at 42 CFR 424.44 define the timely filing period for Medicare fee for service claims. In general, such claims must be filed to the appropriate Medicare claims processing contractor no later than 12 months, or 1 calendar year, after the date the services were furnished."

But keep in mind, the timely filing requirement can vary. Take Horizon BCBS of NJ, for example. Their timely filing requirement state that the claim must be submitted within 180 days (almost 6 months) from the date of service, and correct claims within 365 days:

"Claims must be submitted within 180 calendar days from the date of service.
The claim will be denied if not received within the required time frames.
Corrected claims must be submitted within 365 days from the date of service."

To see the full Horizon BCBS of NJ timely filing requirements, follow this link: http://www.horizonnjhealth.com/for-providers/resources/claims

So how do you know what the insurers timely filing requirements are? You can usually find it listed right on their website in the provider resources/manual or the claims filing information, or simply ask one of the representatives at the insurance company.
 
So what happens if you file a claim after the timely filing period? That will also vary from insurer to insurer.
Some insurers will simply deny the claim all together, and some insurer will charge you a certain percentage as a "late filing charge" but still go ahead and process the claim.