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Denials & appeals

What is the timely filing limit for Cigna, Aetna, UnitedHealthcare, Blue Cross, Medicare and Medicaid?

It depends on the payer, and often on your state and your contract as well. Checked against each payer’s own documents on September 19, 2026: Medicare allows one calendar year from the date of service and TRICARE one year. Medicaid programs must require claims within 12 months, and each state sets its own deadline inside that. Cigna publishes 90 days for in-network providers and 180 for out-of-network, and the behavioral health networks of both Cigna and UnitedHealthcare publish 90 days. UnitedHealthcare’s general guide sends you to your agreement, Aetna’s national manual gives no number, and Anthem and the other Blue Cross plans differ by company, state and product.

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What each payer publishes, at a glance

For a professional claim (CMS-1500 or 837-P) from an outpatient mental health practice. Every row is a summary; the section it links to quotes the document, links it, and says what can override it, and the Sources list gives each document’s date where the document prints one. Several of the commercial defaults below give way to a longer period in your agreement or in state law, so treat each one as a starting point to confirm, not the number that governs your claims.

Cigna
90 days after the date of service in network, 180 days out of network, unless law or your agreement allows longer
Evernorth Behavioral Health (Cigna)
90 days from the date of service, or as your provider agreement defines
Aetna
No number in its national manual; 120 days in New York
UnitedHealthcare
No general number; set by your participation agreement. The guide prints limits for its Oxford and Empire Plan supplements
Optum Behavioral Health (UnitedHealthcare)
90 calendar days from the date of service, or as law or the member’s plan allows
Blue Cross Blue Shield
No single number; it varies by company, state and product (for example 90 days or your agreement’s timeframe at Anthem in Connecticut, no number beyond your agreement at Anthem in Georgia, 365 or 180 days at BCBS of Texas)
Humana
Medicare Advantage: 1 year from the date of service, unless your agreement or law says otherwise; Medicaid: the state’s manual
Medicare (Part B)
1 calendar year after the date of service, set in federal regulation
Medicare Advantage
Set by each plan (and, in network, your agreement); CMS lets MA plans set their own billing procedures
Medicaid
No later than 12 months under federal rules; each state sets its own (90 days in New York, 95 in Texas, 365 in Washington)
TRICARE
1 year after the services are provided

Checked September 19, 2026. Payers revise these documents; before you rely on a date, open the source linked in the section below and confirm it still says the same thing.

What is Cigna’s timely filing limit?

Ninety days after the date of service for a participating provider, and 180 days for an out-of-network provider. Cigna’s claims submission page gives both figures and then lists when more time applies: when “applicable law requires a longer filing period” or your “provider agreement specifically allows for additional time.”

For mental health, Cigna’s behavioral network is Evernorth Behavioral Health, which its own guidelines describe as “a subsidiary of The Cigna Group” and “the behavioral network for customers with Cigna Healthcare plans.” The Evernorth Behavioral Health Administrative Guidelines (March 2026) say: “We will only consider claims submitted within 90 days of the date of service or as otherwise defined in your Provider Agreement and the exceptions noted below.” Where state law provides a longer limit, that limit applies, and a claim filed on time that Evernorth returns asking for more information has its 90 days reset to the date of that request.

If Cigna is the secondary payer, the clock runs from the processing date on the primary payer’s explanation of benefits, not from the date of service. Both documents say so. Appeals are a separate window: 180 calendar days from the initial payment or denial notice.

What is Aetna’s timely filing limit?

Its national provider manual does not give one. The national provider manual (dated June 2026) defines a clean claim as “a claim that is received in a timely manner” and gives no number of days, so the limit that applies to you is the one in your Aetna agreement.

Aetna does publish two narrower figures. Its state supplement (July 2026) says that in New York, “Providers must initially submit claims within 120 days after the date of the service,” unless you agreed a more favorable time frame or the law requires a different one. And its employee assistance program manual tells EAP providers to “submit your claim 90 days from the last session date.” That EAP figure is for EAP sessions only.

The 180-day figures in the Aetna commercial documents cited here are dispute windows, not filing limits: reconsideration “within 180 calendar days of the initial claim decision,” then an appeal “within 60 calendar days of the reconsideration decision,” and up to 180 days to appeal a commercial decision that did not qualify for reconsideration. We could not find a single national filing limit in Aetna’s current manuals, so treat any you see quoted as something to confirm against your agreement.

What is UnitedHealthcare’s timely filing limit?

Its general guide does not publish one. The 2026 administrative guide (effective April 1, 2026) answers the question in one line: “Refer to your internal contracting contact or Participation Agreement for timely filing information.” Elsewhere it adds that “Timely filing limits vary based on state requirements and contracts,” and that without an agreement you should “follow state and federal guidelines.” Whatever your agreement says also covers corrected claims, which the guide says must arrive inside the same number of days. Reconsideration and appeal together get 12 months from the original explanation of benefits or remittance, unless the law or your agreement says otherwise.

The guide does print numbers in two of its plan supplements. The Oxford commercial supplement gives 90 days in Connecticut, 90 or 180 days in New Jersey depending on the provider and member, and 120 days in New York, counted from the date of service; an Oxford agreement with its own deadlines governs instead. The Empire Plan supplement says to submit “no later than 120 days after the end of the calendar year in which covered services are rendered, unless your contract states otherwise,” but that is for the Medical/Surgical Program UnitedHealthcare administers. The same supplement says the Empire Plan’s “Mental Health and Substance Use Disorder Program is administered by Carelon Behavioral Health Solutions,” so for a mental health claim for an Empire Plan member, check Carelon’s rules rather than this one.

For mental health, the guide says specialized benefits are “delivered by our affiliate company United Behavioral Health, operating under the brand Optum,” and that this “may be available to members depending on their health benefit plan.” The Optum Behavioral Health network manual (effective September 1, 2026) does publish a number: “All information necessary to process claims must be received by Optum no more than 90 calendar days from the date of service, or as allowed by state or federal law or the member’s specific benefit plan.” Corrections to a claim have 90 days from when Optum first received it, which is a different starting point from the date of service.

What is the timely filing limit for Blue Cross Blue Shield plans?

There is no single one, because Blue Cross Blue Shield is not a single insurer. The Blue Cross Blue Shield Association describes the system as independent, community-based and locally operated companies, and the ones below give different answers, sometimes within one company:

  • Anthem varies by state. Its 2026 commercial provider manuals give 90 days from the date of service in Connecticut (or the timeframe in your agreement) and Nevada, and, stated as your agreement’s timeframe, 90 days for participating and 365 for non-participating providers in Missouri. The Georgia and Ohio manuals give no number: claims “must be submitted within the timely filing timeframe specified in the Provider or Facility Agreement.”
  • BCBS of Illinois: 180 days from the date of service for its PPO, Blue Choice PPO, Blue HPN and MyBlue Plus (POS) plans, per its commercial provider manual (January 2026), which covers its non-HMO commercial plans only. When it is the secondary payer, 180 days from your receipt of the primary payer’s explanation of benefits. It adds that some employer groups have different time frames.
  • BCBS of Texas: 365 days from the date of service for PPO plans and 180 days for HMO plans. Same company, two numbers.
  • Florida Blue: the time in your participating provider agreement, unless the law requires longer, per its provider manual. The manual adds that, where it applies to a particular benefit agreement, Florida law provides for filing within 180 days after the date of service and your receipt of the patient’s insurer details, and a reminder in its section on supplemental diagnosis claims states that “All claim submissions have a 180-day timely filing limit.”

Two more things to check. First, a patient from another state’s Blue plan is billed through the BlueCard program to your local plan, which the BlueCard provider manual calls “your sole contact for claims payment, adjustments and issue resolution.” We could not find a Blue document that says whose filing limit governs those claims, so ask your local plan rather than assume. Second, when a behavioral health benefit is administered by a separate company, that company’s rules can differ from the plan’s. If you are in Carelon Behavioral Health’s network, for example, its provider handbook says participating providers must file “within 90 calendar days from the date of service” unless the provider agreement says otherwise. Check which company your agreement is actually with.

What is Humana’s timely filing limit?

For Medicare Advantage, one year from the date of service. Humana’s 2026 provider manual lists the limits “if not otherwise specified by the agreement or applicable state or federal law”: “Medicare lines of business: 1 year from date of service”, and for Medicaid, “Refer to the state-specific Medicaid provider manual.”

The manual lists no commercial line. Humana announced in February 2023 that it would exit its employer group commercial medical business, and its 2026 manual lists filing limits only for Medicare and Medicaid lines.

What is the Medicare timely filing limit?

One calendar year from the date of service. Under 42 CFR 424.44, for services on or after January 1, 2010, the claim “must be filed no later than the close of the period ending 1 calendar year after the date of service.” The CMS Medicare Claims Processing Manual, Chapter 1 (§70) says the same thing in its own words.

One detail matters for a practice. For professional claims that carry span dates, CMS uses “the line item ‘From’ date” to decide whether the claim is on time. And a Medicare timely-filing denial is close to final: the same manual says it “is not subject to appeal.” The four narrow exceptions, and what is still worth doing, are in our guide to claims past the timely filing deadline.

Medicare Advantage is different. CMS’s Medicare Managed Care Manual, Chapter 4 says “MA plans need not follow original Medicare claims processing procedures” and “may create their own billing and payment procedures.” So for an in-network practice, an MA plan’s filing limit comes from that plan and your agreement with it. If you are out of network, look up the plan’s own rules for non-contracted providers rather than assuming. Humana’s, for example, is one year from the date of service unless your agreement or the law says otherwise.

What is the Medicaid timely filing limit?

Each state sets its own, inside a federal ceiling. Under 42 CFR 447.45(d)(1), “The Medicaid agency must require providers to submit all claims no later than 12 months from the date of service.” States can and do require less: New York requires claims to be initially submitted within 90 days of the date of service, Texas within 95 days, and Washington within 365 days.

That is a four-fold spread between three state programs, and it is why no single Medicaid number exists. If your Medicaid patients are enrolled in a managed care plan, check that plan’s manual and your agreement with it rather than borrowing the state’s fee-for-service figure.

What is TRICARE’s timely filing limit?

One year. 32 CFR 199.7(d) requires claims to be filed “no later than one year after the services are provided.” If a claim filed on time is returned for more information, the deadline becomes the later of one year after the services or “90 days from the date the claim was returned.” The regulation also lists a small set of exceptions, such as retroactive eligibility and administrative error, under which the deadline may be waived.

When does the clock start on a secondary claim?

For the payers that say, from the primary payer’s decision rather than the date of service. Cigna and Evernorth count from the processing date on the primary payer’s explanation of benefits. BCBS of Illinois allows 180 days after you receive the primary’s explanation of benefits. UnitedHealthcare’s Oxford supplement allows 90 days from the date of the primary carrier’s explanation of benefits when coordination of benefits caused the delay. The Optum Behavioral Health manual states no separate clock for secondary claims.

In practice that means keeping the primary payer’s remittance date with every secondary claim, because it is the date you will be asked to prove.

How do you find the limit that actually applies to your practice?

Work down this list, and stop at the first place that gives you a number in writing.

  1. Your agreement with the payer. UnitedHealthcare’s guide, Anthem’s Georgia and Ohio manuals and Florida Blue’s manual send you there, and Cigna, Evernorth, Humana and Carelon each let it override their published default.
  2. Who actually administers the mental health benefit. Optum for UnitedHealthcare, Evernorth for Cigna, and in some Blue plans Carelon or another company. A claim sent on time to the medical plan printed on the card can still be late at the behavioral health administrator.
  3. The payer’s provider manual for your state. The same payer publishes different numbers by state and by product, as Anthem, BCBS of Texas and Aetna’s New York supplement show.
  4. State law. Several of the documents above let a longer state limit override their own, and Florida Blue’s manual states Florida’s.

Then write the answer down for your top five payers, with the document and the date you read it. That list is worth an afternoon. If a claim has already gone past the window, what you can still do depends heavily on the payer, and how to work old accounts receivable is its own guide.

Key takeaways

  • Medicare is one calendar year from the date of service, in regulation, and a timely-filing denial there is not appealable. Medicare Advantage plans set their own.
  • Medicaid must be no later than 12 months, and states set their own inside that: 90 days in New York, 95 in Texas, 365 in Washington.
  • Cigna publishes 90 days in network and 180 out of network. Evernorth and Optum, the behavioral health networks for Cigna and UnitedHealthcare, both publish 90 days.
  • UnitedHealthcare’s general guide and Aetna’s national manual give no general commercial number. Your agreement is the document that counts.
  • Blue Cross Blue Shield is many companies, and one company can publish different numbers by state or by product.
  • Reconsideration and appeal windows are separate deadlines, and the 180-day figures on Aetna’s commercial dispute page are dispute windows, not filing limits. What to do once a mental health claim is denied is its own guide.

Where this fits in what we do

We do the billing for outpatient mental health practices at 3% of the insurance payments we collect, with a $1,000 a month minimum, no setup fee, month to month. The part of that which bears on this page is plain: every claim is reviewed before it goes out, acknowledgments and rejections are read the day they arrive, and the filing and appeal windows for your payers are tracked as deadlines rather than discovered afterwards. The whole price is published, and what billing companies usually charge is its own guide.

If you want to know what is sitting in your aging report today, including which claims still have a window and which are past it, that is what the free Revenue Leakage Analysis is for. You send an aging report, recent remits and a claims export over a BAA-covered channel we set up with you, never through the web form, and within five business days of receiving them you get a written account of what we see. No obligation. More on how the service works is on the homepage FAQ.

Sources

Each checked on September 19, 2026.