Timely filing limits in dental billing
Timely filing is a payer’s deadline for receiving a claim, usually counted from the date of service. Each payer sets its own limit, in its contracts and plans. A claim that arrives late is denied with reason code 29, “the time limit for filing has expired”, and in network the practice usually cannot bill the patient.
Also calledTimely filing limitFiling deadlineCARC 29CO-29
By Dr. Maya Arnaout, DDS, VP of RevenuePublished 4 min read
What is a timely filing limit?
Every payer sets a window for receiving claims. It usually starts on the date of service and ends a set number of days later; the number is in the provider contract or the payer’s provider manual. Some payers count certain claims from a different date, such as the date of the primary payer’s EOB for a secondary claim.
Corrected claims, secondary claims and appeals often have deadlines of their own, separate from the first claim.
How long is the timely filing limit?
It varies by payer, by plan and by contract, and it can change when a contract is renewed. No one number holds for every dental plan, so do not rely on a list from another office. Check each payer contract and provider manual, and keep every payer’s limit in one place.
Check each payer contract
What does CARC 29 mean?
CARC 29 reads “the time limit for filing has expired”. It usually comes under group code CO, contractual obligation, so an in-network practice writes it off rather than billing the patient. It is lost revenue, not a fee schedule difference: post it as a denial write-off so it shows in your net collection rate.
Appeal only with proof the claim reached the payer or the clearinghouse in time: the clearinghouse acceptance report, the payer’s claim acknowledgment (the 277CA) or a dated portal confirmation. Without proof there is little to appeal on.
Why do claims miss the deadline?
- The claim was never sent: a completed procedure with no claim, or a claim left unsent in the PMS.
- The clearinghouse rejected the claim for a missing or wrong field and nobody fixed and resent it. A rejected claim was never received.
- The claim went to the wrong plan first, because the order of coordination of benefits was wrong.
- A secondary claim waited for a primary EOB that was never posted.
- A claim denied for missing information was not corrected and resent before the deadline.
How should a practice track timely filing?
- Keep each payer’s limit, taken from its contract, in one table, with the date you last checked it.
- Run the unsent and unpaid claims reports every week, oldest first.
- Work clearinghouse rejections the day they come back.
- Call the payer about any claim that has used most of its window with no payment and no acknowledgment.
- Save proof of every submission, so an appeal has something behind it.
Owen Castillo · Sample Plan A, limit 120 days
Day 101 of 120
No acknowledgment from the payer yet: call them
Dana Whitfield · Sample Plan C, limit 365 days
Day 140 of 365
Rejected for a missing tooth number: fix and resend
Ella Brooks · Sample Plan B, limit 180 days
Day 64 of 180
Accepted by the payer, waiting on payment
How ScoutIQ handles it
ScoutIQ starts once the payer has answered, so it does not send claims or watch claims that were never sent. When a remittance comes back with CARC 29 or any other denial, the claim goes to its own queue with the payer’s reason and the days left to appeal, and Atlas ranks denials to appeal and claims missing information in the team’s daily work.
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ERAs and EOBs read; EFT, check and card payments reconciled.
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