Why there is no universal table
Dental timely filing limits are contractual. They vary by carrier, product line, state, and negotiated agreement, so two practices can have different limits with the same payer. Three sources of variation deserve particular attention:- Per contract. Each PC’s participation agreement with each carrier sets its own limit. A DSO with ten PCs has ten sets of limits, not one.
- Per Delta member company. There is no national Delta number. Each of the 39 member companies sets timely filing in its own participation agreement and dentist handbook, so a multi-state group has a different Delta limit per state.
- Per DBA provider manual. Medicaid dental limits live in each dental benefit administrator’s provider manual for each state program, and change at reprocurement.
The limits that can be stated
Medicare Advantage plans are not bound by Medicare’s 12-month limit. Confirm the plan’s contractual deadline instead of applying the fee-for-service rule.
The three windows to record
Each payer has three deadlines, and they differ:
Record all three per payer when you sign the contract.
Proving you filed on time
Clearinghouse acceptance reports are the standard evidence. A 277CA showing payer acceptance on a specific date, or a clearinghouse transmission report, can support a CARC 29 appeal. A PMS screenshot showing “submitted” does not establish that the payer received the claim. Retain acceptance reports for at least the longest appeal window across your payer mix.The exceptions
Each has a documentation requirement. Assemble it with the appeal.
Controls for preventing timely-filing write-offs
1
Enter charges within one business day
The clock starts at the date of service.
2
Work rejections same-day
A claim stuck in a rejection loop is a common cause of timely-filing loss. A 277CA rejection means the payer did not accept the claim into adjudication even if the PMS shows it as “submitted.” A rejected claim sitting for two months has consumed two months of a 90-day window.
3
Run a weekly no-acceptance report
Review every claim submitted more than three days ago with no 277CA acceptance. This can identify claims that did not move successfully from the PMS to the payer.
4
Track held claims against their limits
Claims held during credentialing, awaiting a required preauthorization, waiting on attachments, or pending COB need an aging report with the deadline attached.
5
Set an internal deadline 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
Weekly, by payer.
7
Track timely-filing write-offs as a metric, targeting zero
Any non-zero number gets a root cause and a process change.
The grid template
Verify annually and on every contract renewal or amendment; unilateral amendment clauses mean a limit can change without your signature. See Beat timely filing for the operating workflow.
Sources
- Medicare timely filing: Social Security Act § 1842(b)(3)(B); 42 C.F.R. § 424.44. See CMS, Medicare Claims Processing Manual, ch. 1. Relevant to dental groups only for crossover billing. See Medicare and dental.