What is a timely filing limit, and what happens when you miss it?
Medicaid's timely filing limit is the window a provider has to get a claim to the payer, usually measured from the date of the trip. Federal rules cap it at 12 months, and many payers set shorter windows: 95 days for in-state Texas Medical Transportation Program providers, 90 days in New York, 180 days in Indiana. A late claim is denied unless a documented exception applies.
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The federal ceiling and the deadline that binds you
42 CFR 447.45 requires every state Medicaid agency to make providers submit claims within 12 months of the date of service. That is the general ceiling for a first filing, with narrow exceptions such as claims that wait on a Medicare decision. States are free to demand faster filing, and most programs in the table below do. Health plans and brokers set their own limits in their provider agreements, and those can be shorter again.
The limit that counts is the one set by whoever you bill. A trip for a broker follows the broker’s deadline, not the state’s.
Filing limits in practice
| Payer | First filing limit |
|---|---|
| Texas Medical Transportation Program (TMHP) | 95 days from the ride (Texas providers), 365 days (providers based outside Texas) |
| New York Medicaid (eMedNY) | 90 days from the date of service, with a 2-year outer limit when a delay is documented |
| Indiana Health Coverage Programs | 180 calendar days from the date of service |
| Illinois HFS | 180 days; 24 months if Medicare must adjudicate the claim first |
| South Dakota Medicaid | 6 months following the month of the ride |
| Arizona AHCCCS fee-for-service | Received within 6 months, and clean within 12 months |
| Louisiana ground NEMT, billed to the broker | 365 days from the date of service |
| MTM Health, Rhode Island | 90 days from the date of service |
| MTM Health, Virginia | 6 months from the date of service |
Newly enrolled Texas providers get one extra rule. TMHP counts their 95 days from the day the NPI or atypical provider identifier was issued, and the ride still has to be less than 365 days old.
Exceptions that stretch the clock
Programs list situations that extend or waive the limit. Indiana’s rules are a detailed example, and each one needs documentation sent with the claim.
- Retroactive eligibility. When coverage is granted after the ride, Indiana gives a full year, counted from the day that coverage was recorded.
- Retroactive enrollment or authorization. Indiana gives 180 days from the approval date when a provider’s enrollment or a prior authorization is approved after the fact.
- Another payer went first. When Medicare was billed on time, the federal rule allows the Medicaid claim to be paid as late as 6 months after Medicare’s decision. Indiana allows 180 days from the primary payer’s explanation of benefits when that notice was delayed. MTM Health in Virginia starts its 6-month clock at Medicare’s denial for trips billed there first. See third-party liability.
- Payer error. Indiana waives the limit when the delay was caused by the state or its contractors and you can document it.
Claims can carry a delay reason code for these cases. New York’s list includes codes for authorization delays, third-party processing delays, delays in an eligibility determination, and natural disasters.
How resubmissions count
Fixing a denied claim does not necessarily reset the clock. In Indiana, a denied claim you correct and send back is processed as a brand-new initial claim, so it still has to arrive within 180 days of the ride. Sending the same claim again without changes counts only as a duplicate, and it does not show a good-faith effort to fix the problem. Arizona gives 12 months from the ride to get a claim to clean status. New York expects corrections within 60 days of the payer’s notice.
Voiding is the trap. Once a New York claim is voided, whatever you send next is judged as a first submission, and every timeliness edit runs again. Adjust a paid claim instead of voiding and rebilling it.
Proof of timely filing has to come from outside your own files. Indiana accepts records such as remittance advices, claim status responses, and portal screen prints, and states plainly that provider-made notes and timelines do not count. Our guides on corrected claims and appealing a denied claim walk through both paths, and claim adjustment reason codes explains the codes you will see.
Frequently asked questions
- Which date starts the filing clock, the ride or the day I bill?
- Usually from the date of service, which for NEMT is the day of the ride. South Dakota is one variation: its limit runs 6 months from the end of the month the ride happened, so a January trip must be received by the last day of July. Check whether your payer counts the day it receives the claim or the day you send it. Arizona, for example, counts receipt.
- Can I bill the rider if I miss the deadline?
- Generally no. Federal rules make Medicaid providers accept what Medicaid pays, plus any allowed cost sharing, as payment in full. When a late-filing denial carries group code CO, CMS describes the amount as generally a provider write-off that is not billed to the patient. Texas is explicit for individual transportation participants, who may not charge a client for denied claims. Bill soon after each trip.
- Does a broker follow the state's filing limit?
- Not necessarily. A broker's deadline comes from its handbook and your provider agreement, and some states write one into their own rules. In MTM Health's 2026 handbooks, Rhode Island providers get 90 days from the ride and Virginia providers get 6 months, and both handbooks allow 365 calendar days to appeal a denial. Louisiana's Medicaid manual has ground NEMT providers bill the broker within 365 days.
- What code shows up when a claim is denied as late?
- Claim adjustment reason code 29: "The time limit for filing has expired." To overturn it, you need proof that the claim went in on time, or proof that one of the payer's listed exceptions covers the trip.
