Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date the services were provided, unless an exception applies. The Centers for Medicare and Medicaid Services (CMS) fact sheet indicates that the timely filing period for both paper and electronic Medicare requests is 12 months, or one calendar year, from the date the service is received. Requests are rejected if they arrive after the deadline. When a claim is rejected because it was filed after the one-time filing period, such denial does not constitute an initial determination. Therefore, a determination that a claim was not filed on time is not subject to appeal.
The one-time filing deadline for Medicare claims is 12 months (or 1 calendar year) from the date of service. This applies to both Part A (hospital insurance) and Medicare Part B (health insurance) claims. The deadline means that providers have exactly 12 months from the date the service was provided to file a claim for that service. Paper claims must include a copy of the letter stating the date range of the claims involved or the effective date of the right to Medicare. Requests must be submitted no later than the last day of the sixth calendar month following notification that the government agency has corrected the error.
The one-time filing deadline cannot be extended beyond December 31 of the third calendar year following the year in which the services were provided. For services provided between October and December of a year, the deadline may be extended no later than the end of the fourth year following that year. Providers must submit claims within specific time frames for reimbursement requests to be considered. Given the serious consequences of not meeting reimbursement deadlines, exemption providers must adopt best practices for managing claims efficiently.
