Companion to the lesson "Denials, appeals, and the clock"
Build one table per client at onboarding: read every provider agreement and record the limits by contract. Commercial payers set their own filing limits, often 90 to 180 days from service, stated in provider agreements nobody reads until a denial arrives. This table is dull, and it is worth thousands. Client:
Deadlines by Payer
Payer
Timely filing limit
Appeal level 1 deadline
Appeal level 2 deadline
Portal / phone
Notes
Original Medicare
12 months from date of service (42 CFR 424.44)
Redetermination by the MAC: within 120 days of the initial determination
Reconsideration by the QIC: within 180 days of the redetermination
Levels 3–5 (ALJ, Appeals Council, federal court) exist; small practices live at levels one and two
Watchlist (claims approaching a limit)
Date of service
Payer
Days since service
Filing deadline date
Action taken
The clock that never forgives: a claim that dies past timely filing is denied with no appeal on the merits, and the practice generally cannot bill the patient for it either. The narrow exceptions do not include "the biller was busy." Claims sitting at 300 days from service are already dead or dying. The billers who lose practices are rarely the ones who made an error; they are the ones who let the error sit quietly for a year.