Insurance term
Timely Filing Limit
Definition
The timely filing limit is the deadline, set by the payer or the provider's contract, for submitting a claim after the date of service.
Why it matters for the front desk
Limits vary widely by payer, and some are as short as 90 days. A claim that arrives after the deadline is denied, often with CARC 29, and an in network office usually can't bill the patient for it. A rejected claim doesn't stop the clock, so a claim bounced by the clearinghouse still has to be fixed and resent before the limit runs out. Many payers also set separate deadlines for corrected claims and appeals. Knowing each major payer's limit, and working rejections and denials quickly, keeps earned production from aging out.
Related reading
Related terms
- CARC (Claim Adjustment Reason Code) A CARC is a standard code a payer puts on an ERA or EOB to explain why a claim or service line was paid differently from what was billed.
- Clearinghouse A clearinghouse is a company that passes electronic claims, eligibility checks and payment information between a dental practice and insurance payers.
- EOB (Explanation of Benefits) An EOB is a statement from the insurance payer that explains how a claim was processed: what was billed, allowed, paid, adjusted and left for the patient.