skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
En Español
Text Size:
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 6/6/2020 Location: FL, PR, USVI Business: Part A, Part B

Claims timely filing guidelines FAQ

Q: What are the claim timely filing guidelines? How can I prevent claim denials and/or rejects for untimely filing?
A: Per Medicare guidelines, claims must be filed with the appropriate Medicare claims processing contractor no later than 12 months (one calendar year) after the date of service (DOS). Claims must be processed (paid or denied/rejected) by Medicare in order to be considered filed/submitted. Claims with missing, invalid or incomplete information that prevents Medicare from processing them, also known as “returned to provider/RTPs” (Part A) and “return unprocessable claims/RUCs” (Part B), are NOT considered filed/submitted. RUCs and RTPs must be corrected and resubmitted for processing. Claims submitted after one calendar year from the DOS will be denied or rejected.

Key points to prevent this denial

For all claims:
Claims with a February 29 DOS must be filed by February 28 of the following year to be considered filed timely.
Electronic claims -- The electronic data interchange (EDI) system accepts claims 24/7; however, claims received after 6 p.m. eastern time (ET) or on a weekend or holiday are considered received the next business day.
Paper claims -- Timeliness is calculated based on contractor receipt date, not the postmark date when the claim was mailed, so please allow time for mailing.
For claims with “span dates of service” (“from” and “through” date span on the claim):
Part A institutional claims – “Through date” is used to determine the DOS for claim timely filing.
Part B claims – “From date” is used to determine the DOS for claim timely filing.
Exceptions allowing extension of time limit:
Exceptions to the 12-month timely filing period are limited and very specific as outlined in the Centers for Medicare & Medicaid Services (CMS) internet-only manual (IOM) Medicare Claims Processing Manual, Chapter 1 external pdf file.
Source: CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 1 external pdf file; Section 6404, Patient Protection and Affordable Care Act (PPACA) external pdf file; Code of Federal Regulations Title 42 CFR 424.44 - Time limits for filing claims (http://www.ecfr.gov external link )
Please use your browser's back button to return to the referring page.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.