Prerequisites
- Each payer’s timely filing limit, recorded from the contract
- Clearinghouse acceptance reports retained
- A held-claims report
Know your limits
Dental payers’ limits are contract-specific. There is no industry standard, so record the deadline in each participation agreement.
Record each payer’s deadline in your tracking grid when you sign the contract. Some contracts allow only 90 days, which can be shorter than a credentialing delay or appeal cycle. This deserves attention after an acquisition, when claims may be held while credentialing under the buyer’s TIN is completed.
There are also separate, usually shorter, windows for corrected claims and appeals. Record all three per payer. See Timely filing limits by payer.
Prove you filed on time
Use clearinghouse acceptance reports as evidence. A 277CA showing that the payer accepted the claim on a specific date, or a clearinghouse report showing successful transmission, supports a timely-filing appeal. A PMS screenshot marked “submitted” shows only that someone initiated submission, not that the payer received the claim. Retain acceptance reports for at least the longest appeal window across your payers.The recognized exceptions
Where the deadline can be extended or excused:
Each has a documentation requirement. Assemble it with the appeal.
The guardrails
Getting timely-filing write-offs to zero is a process problem, not a diligence problem.1
Enter charges within one business day
The clock starts at the date of service, not at charge entry. Every day of lag is a day of the window consumed.
2
Work rejections same-day
3
Run a no-acceptance report weekly
List every claim submitted more than three days ago with no 277CA acceptance. This report identifies claims that left your system but never reached the payer’s accepted-claim inventory.
4
Track held claims against their limits
Claims held during credentialing, awaiting a required preauthorization, or pending COB resolution need an aging report with the deadline attached. See Handle credentialing delays.
5
Set an internal deadline well inside the contractual one
If the limit is 90 days, escalate anything unfiled at 45. The buffer absorbs the rejection loop.
6
Alert on approaching deadlines
A daily or weekly report of unfiled claims within 30 days of their limit, by payer.
7
Track timely-filing write-offs as a metric
Target zero. Any non-zero number gets a root cause and a process change.
Appealing a CARC 29
1
Find the proof
Clearinghouse acceptance report, 277CA, or transmission confirmation showing the original submission date.
2
Write the appeal
State the original submission date, attach the acceptance report, cite the contract’s filing limit, and show the submission fell within it.
3
If there was genuinely no timely submission, check for an exception
Retroactive eligibility, COB delay, payer error, or a retro-effective enrollment date.
4
If neither applies, write it off, with a root cause
And fix the process that caused it. A timely-filing write-off with no process change will recur.
Verify it worked
- Every payer’s initial, corrected-claim, and appeal windows recorded, including separate entries for each Delta member company and Medicaid dental benefit administrator
- Charges entered within one business day
- Rejections worked same-day
- Attachments ride with the claim, not after it
- Weekly no-acceptance report running
- Held claims tracked with deadlines
- Internal deadline set inside the contractual one
- Approaching-deadline alerts configured
- Acceptance reports retained for the longest appeal window
- Timely-filing write-offs tracked, targeting zero