Dental Insurance Processing
A claim submitted one day past deadline is a claim you'll never collect. The insurance company denies it automatically. You can't transfer the balance to the patient because they fulfilled their obligation by having active coverage. The revenue vanishes completely from your accounts receivable, and there's nothing you can do to recover it. Timely filing denials differ from other claim rejections because they're final. You can appeal coding errors, provide missing documentation or clarify medical necessity. But once you miss a filing deadline, that door closes. The payer has no obligation to pay, and most provider contracts explicitly state this limitation. This guide walks you through the regulatory requirements governing timely filing, shows you how to calculate exact deadlines for each payer type, and provides systematic approaches to monitoring compliance. You'll learn what documentation protects you when carriers dispute filing dates, how to handle the narrow exceptions that exist for late submissions, and which tracking methods prevent claims from approaching their deadlines unnoticed.
Nov 22, 2025
What Timely Filing Means for Your Dental Practice
Timely filing is the regulatory deadline for submitting insurance claims after you provide services. Miss the deadline and payers automatically deny the claim.
Medicare requires claim submission within 12 months of service under 42 CFR 424.44. Medicare will deny payment for claims filed beyond this deadline. Federal regulations at 42 CFR section 424.44(b) provide limited exceptions when "good cause" exists, such as serious illness, destruction of records or misleading information from the insurance company. Practices should consult their Medicare contractor for specific exception criteria.
Private dental insurance follows different rules. Each carrier sets filing limits through your credentialing agreement. These deadlines range from as short as 30 days to as long as 12 months depending on the payer and your network status. You're likely managing multiple payers, each with different rules, and keeping track feels overwhelming.
The American Dental Association sets professional standards for claim preparation through the ADA claim form. Following these standards from day one prevents processing delays that push claims toward deadline limits.
What Missed Deadlines Cost Your Practice
Missing a timely filing deadline means you lose that payment entirely. The claim is denied, you cannot bill the patient for services already rendered, and the revenue disappears from your books.
The operational consequences compound the financial loss. Your team spends time appealing unappealable denials, creating administrative waste that could have prevented the problem. Payment delays for other claims stretch longer while staff manages the backlog. Revenue becomes unpredictable, making it harder to plan staffing, equipment purchases or practice growth.
Understanding specific carrier deadlines helps you build the systems needed to prevent these losses.
Filing Deadlines by Insurance Type
Your practice likely works with multiple payers, each with different filing requirements. Different insurance categories maintain distinct deadline structures based on their regulatory frameworks. Here's what research shows about major carriers and how their requirements vary across program types.
Medicare Programs
Traditional Medicare maintains the 12-month standard established by federal regulation. This applies regardless of which Medicare Administrative Contractor serves your region.
Medicare Advantage plans operate differently. As of October 1, 2019, Medicare Advantage plans require submission within 90 days, Anthem New York reports. The carrier "will refuse payment" for claims submitted after this deadline.
This creates a critical distinction. Medicare Advantage plans maintain carrier-specific requirements that differ significantly from traditional Medicare.
Commercial Carriers
Commercial insurance carriers set their own filing deadlines through provider contracts. The variation between participating and non-participating provider requirements creates complexity for practices managing multiple network relationships. Here's what each major carrier requires for claim submission:
Cigna Dental: 90 days for participating providers, 180 to 365 days for non-participating providers
UnitedHealthcare: 90-day standard with 30-day preferred submission timeline
Ameritas: 90-day filing limit across all dental products
Delta Dental: Generally allows 12 months for claim submission
Humana Connection: 12 to 15 months depending on the product line
These varying deadlines create real financial risk when your practice misses them.
State Medicaid Programs
State Medicaid dental programs create their own timely filing deadlines through administrative rules. Each state operates independently under federal guidelines, resulting in substantial variation across the country. Requirements range from 180 days to 12 months:
Illinois Medicaid: 180 days (6 months)
Ohio Medicaid: 365 days (1 year)
California Denti-Cal: 1 year from the month of service
Michigan and Virginia Medicaid: 12-month deadlines
The shortest Medicaid deadline documented is Illinois at just 6 months.
How to Calculate Your Timely Filing Deadline
Understanding the deadline is one thing. Calculating it correctly for each claim is another. Here's how to determine your exact filing deadline.
Basic Calculation Method
The foundation of timely filing compliance starts with accurate deadline calculation. Every claim requires determining the exact calendar date when the filing window closes.
The formula is straightforward. Take the date of service and add the carrier's filing limit to determine your deadline.
For a service provided on March 15, 2025 with a 90-day filing limit, your deadline is June 13, 2025.
Calendar Days vs. Business Days
Most insurance carriers count calendar days, not business days. This means weekends and holidays count toward your deadline. A 90-day deadline includes every single day on the calendar.
Some carriers specify business days in their provider agreements. Review your contract language carefully. When in doubt, assume calendar days to protect your filing window.
Month-End and Variable-Length Months
Services provided at month-end create calculation challenges. A service on January 31 with a 90-day limit reaches May 1, not May 2. You count 90 days forward from the service date.
For month-based deadlines (common with Medicaid), count full calendar months. A service on January 15 with a 6-month deadline expires on July 15, not July 31.
Weekend and Holiday Deadline Scenarios
When your calculated deadline falls on a weekend or holiday, carrier policies vary. Some automatically extend to the next business day. Others enforce the calendar date regardless.
UnitedHealthcare and Cigna typically do not extend deadlines for weekends. If your 90-day deadline falls on Saturday, you must submit by Friday. Medicare contractors generally follow federal holiday schedules and may extend deadlines, but verify with your specific MAC.
Create a deadline tracking system that flags claims approaching weekend deadlines at least 5 business days in advance.
Practical Calculation Tools
Manual deadline tracking becomes impractical as claim volume increases. Automated calculation tools reduce errors and save your team significant time. Here are the most practical approaches for different practice sizes and technical capabilities:
Spreadsheet formulas help automate deadline tracking in Excel or Google Sheets. For day-based deadlines, use
=DATE(YEAR(A2),MONTH(A2),DAY(A2)+90)where A2 contains the service date. For month-based deadlines, use=EDATE(A2,6)for a 6-month limit.Practice management software calculates deadlines automatically when you enter the service date and payer. Verify these calculations quarterly, as software updates sometimes introduce errors.
Manual calculation works by counting forward on a physical calendar and marking the exact deadline date. This approach is best for high-value claims requiring extra attention.
Example Calculations
Walking through specific scenarios helps clarify how calculation rules apply in real situations. These examples demonstrate common deadline scenarios your practice encounters regularly:
Routine cleaning scenario. A routine cleaning on February 10, 2025 billed to Cigna has a 90-day participating provider limit. The calculation goes February 10 + 90 days = May 11, 2025. Set your internal deadline for May 4, 2025 to maintain a one-week buffer.
Weekend deadline scenario. An extraction on August 31, 2025 billed to Medicare Advantage has a 90-day limit that falls on Saturday. The calculation goes August 31 + 90 days = November 29, 2025 (Saturday). The carrier requires submission by November 28, 2025 (Friday). Set your internal deadline for November 21, 2025 to maintain a one-week buffer.
Setting internal deadlines earlier than payer deadlines creates the safety margin your practice needs when problems arise.
What to Do When You Miss a Deadline
Federal regulations and insurance carriers provide limited options for late filing under specific circumstances. Exceptions to timely filing deadlines may be considered when "good cause" exists.
Good Cause Exceptions
The Centers for Medicare & Medicaid Services recognizes specific qualifying circumstances. These exceptions apply narrowly and require substantial documentation to support your claim. Understanding which circumstances qualify helps you determine whether appeal efforts are worthwhile:
Serious illness of the provider or key billing staff that prevented contacting the appeals reviewer
Death or serious illness in the immediate family that disrupted normal business operations
Destruction or damage of important records by fire, natural disaster or other catastrophic events
Misleading information from the insurance company regarding deadline dates or appeal rights
Delayed information requests caused by administrative errors within the insurance company or government agency
However, these exceptions are narrowly defined. Practices should consult their Medicare contractor for specific exception criteria. For private insurance, timely filing requirements are set through individual insurance contracts between providers and payers. Late filing options vary by carrier.
The federal regulation codified at 42 CFR Part 405 Subpart I establishes that Administrative Law Judges must apply uniform standards when determining whether good cause exists for late filing. Medicare claims follow federal regulations at 42 CFR 424.44, which require a mandatory 12-month filing deadline from the date of service.
For ERISA-governed employer dental plans, federal regulations at 29 CFR § 2590.715-2719 require plans to consider extensions when there is "good cause or due to matters beyond the control of the plan."
Understanding Corrected Claims
Corrected claims that fix errors in previously submitted claims typically preserve your original filing date, provided the original was filed on time. Most payers do not apply new timely filing deadlines to corrections. However, if the original claim was denied for late filing, corrections cannot fix that missed deadline. Include the original claim number when submitting corrections and use the appropriate frequency code to link your correction to the timely-filed original.
Documentation to Prove Timely Filing
When payers dispute whether you filed on time, documentation determines whether you get paid or lose the revenue. You need proof of submission that withstands carrier challenges.
Electronic Confirmation Reports
Electronic submissions create verifiable transmission records. Your clearinghouse generates reports showing the exact date and time your claim was transmitted to the payer. Payers accept these transmission records as definitive proof of filing dates because they come from neutral third-party systems. These reports typically include:
Claim identification number
Patient name and account number
Transmission date and timestamp
Payer identification
Confirmation or rejection status
The 277CA acknowledgment (Claim Acknowledgment) is the industry standard proving your claim reached the payer's system. Request these reports immediately after each submission batch. Review them for any rejected claims that might need resubmission. File them systematically by payer and date for easy retrieval during disputes.
Some clearinghouses offer dashboard views showing all transmitted claims with color-coded status indicators. These visual tools help identify submission gaps quickly, but they supplement rather than replace the detailed 277CA reports you need for disputes.
Paper Claim Documentation
When you submit paper claims, proof becomes more complicated. Certified mail with return receipt provides the strongest evidence. The signed receipt shows delivery date and creates a presumption of filing.
Regular mail offers no proof of delivery or filing date. Many practices scanning paper claims and submitting electronically eliminate this documentation gap entirely while improving processing speed.
Retention Requirements and Response Protocol
Federal regulations require maintaining claim documentation for at least seven years from the date of service. State laws sometimes mandate longer retention periods. California requires ten years. Check your state's specific requirements.
Store timely filing proof separately from other claim documents. Create a dedicated folder structure: Year > Month > Payer > Confirmation Reports. This organization allows rapid retrieval when carriers send denial letters months after submission.
Cloud-based storage with automated backup protects against the "destruction of records" scenarios that could otherwise derail good cause exception requests. If you can't prove you filed on time because your records were lost, you typically lose the appeal.
When payers deny claims as late-filed despite your timely submission, respond immediately with comprehensive documentation:
Submit the 277CA acknowledgment showing transmission date
Include your batch confirmation report
Reference the specific claim number and patient details
Request written explanation of the payer's filing date determination
Escalate to the payer's claims supervisor if initial appeals fail
Most clearinghouses offer reporting tools that let you run historical searches. If you submitted a claim 60 days ago and can't locate the confirmation, use these search features to reconstruct your filing timeline.
Maintain these records beyond the seven-year minimum for high-value claims. A $3,000 implant case justifies permanent record retention given the potential disputes that might arise years later.
File a Structured Appeal
The National Association of Insurance Commissioners outlines the internal appeal process. Successful appeals follow a consistent format that addresses specific regulatory and contractual requirements. Your appeal letter should include:
Patient/member name and plan identification number
Specific claim number and date(s) of service
Provider name, credentials and contact information
Detailed explanation of why the denial should be reversed
Supporting clinical documentation and relevant policy provisions
Reference to specific federal regulations or carrier policies when applicable
Maintain copies of all submissions and request written confirmation of receipt to make a documented timeline. This documentation is vital when submitting written appeals, the National Association of Insurance Commissioners' consumer guide on appealing denied claims notes.
Document qualifying circumstances immediately when they occur. Maintain comprehensive correspondence files demonstrating carrier delays or misinformation. These records support your case if you need to file an appeal.
Monitoring and Tracking Timely Filing Compliance
You need a systematic approach so no claim ever approaches its deadline unnoticed. Strong monitoring combines reference documentation, tracking tools and regular audits.
Create a Master Payer Reference Document
Build a comprehensive reference listing filing requirements for every contracted payer. This becomes your team's single source of truth for deadline calculations and prevents the confusion that leads to missed deadlines. Your document should include:
Carrier name and product lines
Exact filing deadline (days from service or months)
Calendar days vs. business days specification
Weekend/holiday extension policies
Participating vs. non-participating provider deadlines
Last verified date and contract reference
Update this document whenever you receive contract amendments or credentialing updates. Assign one team member responsibility for maintaining accuracy.
Flag High-Priority Claims
Not all claims carry equal deadline risk. Strategic flagging focuses attention on scenarios most likely to cause problems. Create an alert system for these scenarios:
30-day carriers need immediate attention. UnitedHealthcare preferred submissions should be submitted within 48 hours of service.
90-day carriers need weekly monitoring after day 60. Cigna participating, Ameritas and Medicare Advantage claims fall into this category.
High-value claims deserve manual tracking regardless of carrier deadline. Crowns, implants and major procedures exceeding $1,000 warrant this extra attention.
Month-end services need extra attention due to calculation complexity. Claims provided in the final week of any month require careful monitoring.
Implement Automated Tracking Systems
Your practice management software should automatically flag claims approaching deadlines. Manual tracking becomes impossible as claim volume grows, making automation necessary for consistent compliance. Configure these alerts:
Yellow flag: 75% of deadline elapsed (day 68 of a 90-day limit)
Red flag: 85% of deadline elapsed (day 77 of a 90-day limit)
Critical alert: 90% of deadline elapsed (day 81 of a 90-day limit)
Electronic claim submission platforms generate confirmation reports showing transmission date and time. Archive these confirmations as proof of timely filing. If a carrier later claims late submission, you have documentation showing compliance.
Run Regular Compliance Audits
Monthly audits identify systemic problems before they create significant revenue loss. Regular reviews reveal patterns that indicate workflow breakdowns or training gaps requiring immediate attention. Review these metrics:
Claims filed within internal deadlines should hit 98% or higher. If you're consistently missing your internal buffer, you need workflow changes.
Average time from service to submission should be tracked by payer and procedure type. Implants taking 45 days to bill while cleanings take 3 days signals a documentation bottleneck.
Claims approaching deadlines need immediate investigation. Any claim reaching 75% of its deadline without submission requires action.
Payer-specific patterns might indicate staff confusion. One carrier showing consistently longer submission times suggests team members need additional training on that carrier's specific requirements.
Conduct quarterly deep audits reviewing a random sample of 25 claims per payer. Verify that calculated deadlines match payer agreements and that internal deadlines provide adequate safety buffers.
Assign Accountability
Designate specific team members responsible for timely filing compliance. Clear ownership prevents the diffusion of responsibility that causes claims to slip through gaps.
One person reviews all claims older than 7 days daily. Another person follows up on claims flagged by your tracking system. A third person conducts the monthly compliance audits and reports findings to practice management.
This systematic monitoring approach creates multiple safeguards protecting your revenue from deadline-related losses.
How Teero Helps Maintain Practice Continuity
When your hygienist calls in sick or leaves unexpectedly, the disruption affects your entire practice. Appointment schedules get thrown off. Front desk staff scrambles to reschedule patients. Your billing team falls behind because the regular flow of completed procedures stops.
Teero connects dental practices with qualified hygienists who can step in quickly. You maintain your patient schedule without gaps, which keeps your revenue cycle moving. When hygienists complete procedures on schedule, your administrative team can process documentation and submit claims within normal timeframes.
Staffing consistency protects the systematic workflows your practice depends on for timely filing compliance. Whether you need coverage for a day, a week or longer, Teero helps you avoid the operational disruptions that push claims toward their deadlines. Sign up for Teero today to fill staffing gaps.