Timely filing limits aren’t just a concern for primary claims—they apply to secondary claims too. Missing a secondary payer’s deadline can result in a permanent denial, even if the services were fully covered. Understanding how timely filing works in dual-insurance scenarios is critical to protecting your practice’s revenue.
A timely filing limit is the amount of time you have to submit a claim after the date of service (for primary claims) or after the primary payer has processed the claim (for secondary claims). Each insurance company sets its own deadline, usually measured in days.
For secondary insurance, the clock typically starts from one of two points:
The date the primary insurance adjudicated the claim (i.e., the date of the primary Explanation of Benefits or EOB)
The date the provider received the primary EOB
Most secondary payers base their deadline on the adjudication date, not the date you submitted the claim to the primary.
| Payer Type | Typical Limit |
|---|---|
| Medicare | 12 months from service date |
| Medicaid (varies) | 90–180 days from primary decision |
| Commercial plans | 60–180 days from primary EOB date |
| Supplemental (Medigap) | Often follows Medicare crossover timelines |
Note: Always check the payer’s specific policy—timely filing windows can vary by plan and contract.
If you miss the timely filing limit:
The secondary payer may issue a denial with no payment
You may be prohibited from billing the patient for the denied amount
The claim may be eligible for appeal only with strong documentation of extenuating circumstances
Timely filing denials can result in permanent loss of revenue.
Submit to primary promptly. Late primary submissions delay the entire process.
Track primary adjudication dates. Note the date of the primary EOB to calculate the secondary filing window.
Use billing software alerts. Set reminders or flags for pending secondary submissions.
Verify if crossover applies. If the claim didn’t crossover automatically from Medicare, submit it manually as soon as you receive the EOB.
Maintain good documentation. Keep copies of submission confirmations, EOBs, and internal follow-up notes.
If a claim is denied due to timely filing:
Submit an appeal with supporting documents, such as:
Primary EOB with adjudication date
Proof of timely submission to primary
Explanation for any delay (e.g., payer processing issues)
Include payer-specific appeal forms if required
Follow up regularly to track appeal status
Not all appeals will be successful, so prevention is your best strategy.
Timely filing limits for secondary claims are strict, and they vary by payer. Always submit secondary claims promptly after receiving the primary EOB, track all deadlines carefully, and use system tools to prevent missed windows. Staying on top of this process ensures you collect the full reimbursement your practice is entitled to.